[Total aortic replacement in a patient with extensive thoracoabdominal aortic aneurysm--a case report]

A 35-year-old woman with a form fruste of Marfan's syndrome, presented the extensive thoracoabdominal aortic aneurysm. CT scan, MRI and aortogram revealed that she had a true aneurysm of ascending aorta and aortic arch and chronic DeBakey IIIb dissecting aneurysm extending throughout the descending thoracic and abdominal aorta. The surgical treatment was consisting of two staged operations. At the first operation, ascending aorta and aortic arch were reconstructed under cardiopulmonary bypass and selective cerebral perfusion. Elephant trunk method was employed for the second operation. The second operation was performed by graft replacement of the entire descending thoracic and abdominal aorta with reattachment of intercostal and visceral arteries. She discharged the hospital without any complication including paraplegia.

Surgical treatment of acute aortic dissection: efficacy of retrograde cardioplegia for myocardial protection

The operative morbidity and mortality of patients with Stanford type A acute aortic dissection undergoing urgent operation using retrograde cardioplegia for myocardial protection were evaluated to assess the efficacy of such surgery. A total of 18 patients (12 men and six women, 19-71 years of age) were operated on 9-137 h after onset of dissection using cardiopulmonary bypass with deep hypothermia and retrograde cardioplegia. Graft replacement was performed in ten patients, primary anastomosis in three, and Cabrol and Bentall operations in five. All patients were weaned from cardiopulmonary bypass, but four died in hospital (mortality rate 22%). Thirteen patients were in good health at follow-up ranging from 3 to 98 months, and the remaining patient died from rectal cancer 5 months after surgery. It is concluded that urgent operation of patients with Stanford type A acute aortic dissection can be performed with reasonable operative and excellent follow-up results. Retrograde cardioplegia is an easy and reliable method of myocardial protection to repair the fragile aortic wall.

[Surgical treatment of cardiac myxomas]

Between April 1975 to March 1991, 17 patients (5 man and 12 women, mean age 49.8 years old) underwent surgical treatment for cardiac myxomas. Fifteen patients had left atrial myxomas, and the other 2 had the ventricular myxomas (left ventricular myxoma 1 and right ventricular myxoma 1). In cases with left atrial myxomas, the tumor was resected through the transatrial approach alone in 12 patients, and the left atriotomy was added in other 3. Left ventriculotomy was required to resect the left ventricular myxoma in addition to the atrial approach. Right ventricular myxoma, which attached the outflow tract, could be removed through the small right vertical ventriculotomy. All patients recovered well, and there was no recurrence in any patient during the follow-up period.

Expression cloning of a novel Gal beta (1-3/1-4) GlcNAc alpha 2,3-sialyltransferase using lectin resistance selection

This report describes the isolation of a cDNA encoding a novel human Gal beta (1-3/1-4)GlcNac alpha 2,3-sialyl-transferase involved in the biosynthesis of the sialyl Lewis x determinant (NeuAc alpha 2-3 Gal beta 1-4(Fuc alpha 1-3)GlcNAc). A cDNA library of the human melanoma cell line WM266-4 was constructed in an Epstein-Barr virus-based cloning vector. Selection of the B-cell line Namalwa expressing transfected cDNAs in the presence of the cytotoxic lectin Ricinus communis agglutinin 120 gave a cDNA encoding a protein with type II transmembrane topology, as found for mammalian glycosyltransferases. The use of this lectin, which is specific to galactose residues (especially the Gal beta 1-4GlcNAc structure), originates from our prediction that the modification of the Gal beta 1-4GlcNAc structure (a backbone of the sialyl Lewis x structure) by glycosyltransferases may increase the levels of resistance to this lectin. Comparison of this cDNA sequence with those of three other cloned sialyltransferases revealed two conserved regions shared by all four enzymes. Expression of the COOH-terminal catalytic domain of this protein showed alpha 2,3-sialyltransferase activity with substrate specificity different from that of CMP-N-acetylneuraminate:N-acetyllactosaminide alpha-2,3-sialyltransferase (Gal-beta 1-3(4)GlcNAc alpha 2,3-sialyltransferase, EC 2.4.99.6). Furthermore, expression of this cDNA in Namalwa cells increased the level of sialyl Lewis x antigens. The cloning approach based on lectin resistance may be useful for the isolation of cDNAs encoding other mammalian glycosyltransferases.

[Re-operation for total anomalous pulmonary venous connection twelve years after radical operation]

Thirty five-year-old man required reoperation, twelve years after radical operation of total anomalous pulmonary venous connection (Darling IIb type), because of the clinically apparent pulmonary venous obstruction. The stenosis of ASD was revealed by cineangiocardiography and echocardiography. The fibrous thickening of atrial septal wall and stenosis of ASD were found at the operation. Operating procedure consisted of the enlargement of ASD and cut-back of the atrial septal wall. Postoperative study showed no evidence of stenosis of pulmonary venous return. The patient was discharged well and returned to his job. Late postoperative pulmonary venous obstruction is of particular concern. Usually it occurs within the first few postoperative months. We reported this case because it is rare that pulmonary venous obstruction occurred twelve years after radical operation.

[Surgical treatment of pseudoaneurysm of the left ventricle after myocardial infarction--a case report]

A 62-year-old woman had myocardial infarction with congestive heart failure. Follow-up chest X-rays showed progressive prominent bulging of the left cardiac silhouette. Echocardiography revealed a large echo-free space behind the posterior of the left ventricle. Magnetic resonance imaging and left ventriculogram confirmed the huge pseudoaneurysm of the left ventricle. We performed the operation 4 months later the onset of the myocardial infarction. The pseudoaneurysm was opened under cardio-pulmonary bypass. It contained a large amount of old thrombi and communicated with the left ventricle through several orifices in the inferior left ventricular wall. The orifices were closed primarily with pledged mattress and running sutures. The aneurysmal wall was left unresected. The pathologic study showed no myocardial element nor endocardium in the aneurysmal wall. Postoperative course was uneventful, and she discharged from the hospital in a healthy condition.

[Primary chylopericardium with skeletal lymphoangiomatosis: a case report]

A 5-year-old girl admitted to our hospital complaining cardiomegaly due to pericardial fluid and punched-out area in the humerus. Analysis of pericardial fluid confirmed primary chylopericardium and the findings in the humerus suggested skeletal lymphoangiomatosis. Despite medical treatments, pericardial fluid didn't decrease. Therefore, she underwent ligation and resection of thoracic duct. She recovered uneventfully without reaccumulation of the pericardial effusion. In addition, skeletal survey resulted in lymangiomatosis.

[An outbreak of gastroenteritis due to group C rotavirus in Tokyo]

In April 1991, an outbreak of acute gastroenteritis due to group C rotavirus occurred at an elementary school in Tokyo. Fifty-one (13%) of 393 students became ill. The main clinical symptoms were diarrhea (100%), abdominal pain (68%) and vomiting (56%). No enteropathogenic bacteria were found in the fecal specimens. However, the virus particles morphologically indistinguishable from conventional rotavirus were detected in 6 of 11 fecal specimens by electron microscopy. Immune electron microscopy showed that these virions aggregated with anti-group C rotavirus serum. The RNA pattern of the virus particles involved in this outbreak showed a pattern similar to that of typical group C rotavirus on polyacrylamide gel electrophoresis.

[Left heart bypass using a centrifugal pump as an adjunct measure for surgery of thoracic descending aorta]

We have employed left heart bypass (LHB) using a centrifugal pump with heparin coated tubes as an adjunct measure for surgery of thoracic descending aortic aneurysm in 8 cases. During aortic cross-clamping, LHB was controlled to maintain the distal pressure above 50 mmHg. In 7 cases, hemodynamics were stable and no complication occurred in relation with this method. However, acute heart failure due to coronary insufficiency occurred in one patient, and subsequent cardiopulmonary bypass was required to maintain systemic circulation. LHB provides adequate distal perfusion and proximal decompression in most cases, and it has also contributed to diminution of intraoperative bleeding. However, LHB can not maintain distal perfusion when acute heart failure occurs, which indicates that we have to select another adjunct measures, such as femorofemoral bypass to avoid distal hypoperfusion in cases with heart diseases.

[Outbreaks of acute gastroenteritis caused by small round structured viruses in Tokyo]

Of 34 non-bacterial gastroenteritis outbreaks which occurred at day-care centers, kindergartens, elementary and secondary schools in Tokyo during the period from February 1985 to June 1991, 28 outbreaks from which small round structured viruses (SRSV) were detected in the patients' stool specimens by electron microscopy were subjected to an epidemiological investigation. The outbreaks tended to occur frequently in the cold season; twenty-two (79%) of these outbreaks from November through April. Though detailed epidemiological informations was not obtained from all outbreaks, the common source of infection were presumed to be present in many of the outbreaks, judged from the incidence as to time course of patients. Food doubted to be incriminated as transmission vehicles in these outbreaks was served at schools, kindergartens, and lodgings. In some outbreaks, SRSV was detected from stool specimens of food handlers, or they were seroconverted to SRSV, suggesting that food was incriminated as a transmission vehicle. The symptoms of patients differ slightly from age to age: in the age range of 0 to 6 years, vomiting 90%, fever 41% and diarrhea 32%; in the 6 to 12 year-olds, nausea 61%, vomiting 48%, abdominal pain 65%, diarrhea 20% and fever 29%; and in the 12 to 15 year-olds, nausea 69%, vomiting 42%, abdominal pain 60%, diarrhea 30% and fever 34%. The lower the age of patient vomiting was more frequently observed. In these lower age groups, the frequency of nausea and vomiting tended to exceed that of diarrhea.

[A left subclavian arterial aneurysm ruptured into the left lung--a case report]

A 68-year-old man complained bloody sputum. Angiography revealed the left subclavian arterial aneurysm that was arising from the origin of the left subclavian artery. The aneurysm was resected with the adhesive lung tissue through a left posterolateral thoracotomy in the third intercostal space, and an 8 mm EPTFE graft was implanted between the aortic arch and the left subclavian artery. The aneurysm was filled with old thrombus and it was ruptured into the left lung. The pathologic study showed typical atherosclerotic changes. Postoperative course was uneventful, and his bloody sputum disappeared.

Coronary artery bypass grafting in patients with depressed left ventricular function: operative results and long-term follow-up

Nine consecutive patients with coronary artery disease who had a left ventricular ejection fraction (LVEF) of less than 0.4 and underwent coronary artery bypass grafting (CABG) at our institution were studied. All patients had angina pectoris and six of the nine patients (67%) had a history of congestive heart failure. The mean EF was 0.37 +/- 0.03 and the mean LV end-diastolic pressure was 10.1 +/- 4.9 mmHg. An average of 1.56 +/- 0.50 grafts per patient were placed and there was no operative death. The graft patency rate was 92.9% and the mean EF rose significantly from 0.37 to 0.53 after surgery (P less than 0.05). There was one late death, the 4-year actuarial survival rate being 88.9%. Of the eight long-term survivors, six (75%) were totally asymptomatic and only two had mild angina on exertion. This study confirmed that CABG for patients with depressed LV dysfunction can be performed safely with an acceptably low operative mortality, a significant improvement of LV function, and excellent long-term results.

Measurement of serum myoglobin by a turbidimetric latex agglutination method

We evaluated an immunoturbidimetric quantitation for serum myoglobin by the latex agglutination method using an automated biochemical analyzer. This method is rapid, specific, accurate, precise, and has wide dynamic range. The total assay time is 10 min and is performed at 37 degrees C with continuous monitoring at 570 nm. The assay results were compared with radioisotopic immunoassay results and showed a good correlation coefficient, r = 0.99; Y = 0.98 x + 9.3; N = 79. Sera from healthy adults has a myoglobin concentration in the range of 15-80 ng/ml(N = 362). Sex- and age-related differences were observed. The serum myoglobin levels in males and elderly people showed higher concentration than in females and younger people. The peak elevation of serum myoglobin compared with other cardiac markers was observed within 6 hours after onset of chest pain as well as the CK-isoform ratio (MM3/MM1). All of the serum from 21 patients with definite acute myocardial infarction showed increased serum myoglobin levels (100-1200 ng/ml) upon admission and within 6 hours. The results suggest that assays for serum myoglobin levels are helpful in the early diagnosis of acute myocardial necrosis.

[Coronary artery spasm after aortic valve replacement: a case report]

A 64-year-old man who had aortic valve regurgitation underwent aortic valve replacement. There had been no history of angina pectoris or taking of calcium channel blockers. When the operation was nearly completed, unexpected hemodynamic collapse happened without ST-segment changes on the ECG monitoring. Resuscitation was successful by cardiac massage, pacing and administration of catecholamine. Thereafter the same episodes occurred several times. At the 6th attack on postoperative day 7, we confirmed the ST-segment elevation using 12-lead-ECG, thus coronary artery spasm was diagnosed. Thereafter calcium channel blocker and coronary vasodilator were administered continuously. There has been no attack since postoperative day 13. Though postoperative coronary arteriography showed no anatomical changes compared with preoperative study, direct injection of ergonovine made the right coronary artery spastic, but not the left. We emphasized that perioperative coronary artery spasm may happen not only in the coronary artery surgery but in any other cardiac operations.

[The determination of serum and urine myoglobin]

We have reviewed the current methods of determining serum and urine myoglobin. Qualitative determination of urine myoglobin has been possible for over 20 years, but the quantitative determination is a recent development. Between 1963 (spectrophotometry) and 1978 (radioimmunoassay, RIA), efforts have been made to develop a more sensitive determination method. The RIA method thus developed has a sensitivity as high as 1 ng/ml. Such methods are valuable in the diagnosis of acute myocardial infarction. Recently, simple, rapid, and non-isotopic method such as enzyme immunoassay (EIA) and latex agglutination test have been developed and made rapid determination possible. We applied the "Mb-latex [Seiken]", one such latex agglutination method to the TBA-30 R single-multi type automated analyzer. We obtained good results in the fundamental study such as in precision and accuracy. The reference ranges obtained using serum and urine samples corresponded to the values reported by others with the exception of the lower limit of the ranges. Proficiency testing data using the same reagents and same samples at five laboratories revealed some systematic biases. The reasons for such interlaboratory differences is not clear. However, these systematic biases may be due to the type of equipment, the type of calibration procedure and others including reagents and standard solutions. We are continuing our effort to improve the reliability of interlaboratory data.

[Intracardiac repair in left ventricular rupture following mitral valve replacement]

Rupture of the left ventricle is one of the major lethal complications of mitral valve replacement. We have encountered 11 cases of this complication over a period of 19 years (1971, Apr.-1990, Mar.). Five of 8 cases of intraoperative rupture survived but no patient survived a delayed rupture. In the patients with intraoperative rupture external repair was performed in 6 cases, resulting in 3 survivors, two in type II and one in type I with formation of left ventricular false aneurysm. For selection of surgical treatment accurate recognition of types of rupture is important but the location and size of the endocardial and epicardial defects do not always correspond. Attempts to suture a ventricular rupture on the pressure-loaded beating heart were always unsuccessful and frequently extended the tear. Repair should be accomplished with aid of cardiopulmonary bypass on the decompressed and arrested heart. Recently, we chose internal repair with arrested heart in 2 cases of type I rupture, that is, reopening of the left atrial closure and repair from within the cardiac chamber with removal of the prosthetic valve. Both cases survived. In conclusion, we emphasized importance of intracardiac repair with removal of the replaced prosthetic valve in left ventricular rupture of type I and III following mitral valve replacement for better exposure, more secure repair, and prevention of injury to the circumflex artery.

[Long-term results of total correction of tetralogy of Fallot less than 2 years old]

Between April 1972 and March 1979, eighteen total correction for tetralogy of Fallot less than 2 years old were performed with a mortality rate of 11.1%. The valved patch made of autologous pericardium was utilized for right ventricular outflow reconstruction in 12 of 16 survivors. Late (from 10 to 17 postoperative year) results of the all survivors were studied on functional and clinical status, hemodynamics and cardiac functions, and also, were compared with that of the patients above 2 years of age. All of them were in NYHA class I with no physical exercise limitation. Chest X-ray showed nearly normal CTR of 51.7%. ECG showed complete or incomplete RBBB in 14 patients and LAD in 3 of them, whereas no ventricular arrhythmia. Cardiac catheterization and cineangiography revealed that they had quite satisfactory hemodynamics and cardiac functions despite their moderate pulmonary regurgitation. In comparison with the older patient group, this younger one had a tendency to take superior results in all parameters of cardiac functions and clinical status. These excellent long term results seem to come from their young and less degenerative myocardium at the time of surgery.

[Coronary revascularization using an internal mammary artery-saphenous vein composite graft in a patient with severely calcified ascending aorta]

A 52-year-old woman with angina pectoris resulted from complete obstruction of left coronary ostium required double-vessel bypass. Because of severely calcified ascending aorta, avoidance of aortic cross-clamping was needed for the prevention of embolic injury and aortic dissection. Internal mammary artery (IMA)-saphenous vein (SV) composite graft under hypothermic ventricular fibrillation was successfully performed without any complication. IMA-SV composite graft is a good alternative in a case of insufficient IMA length and limited site for proximal vein graft anastomosis, which can avoid or reduce the manipulation of diseased ascending aorta.

Antigenic characterization of small, round-structured viruses by immune electron microscopy

Small, round-structured viruses (SRSVs) detected from nonbacterial gastroenteritis outbreaks in Tokyo and Saitama Prefecture, Japan, during the period from 1977 to 1988 were tentatively classified into nine antigenic patterns from SRSV-1 (S-1) to SRSV-9 (S-9) by cross-immune electron microscopy (IEM). S-1 and S-2 appeared pattern specific, while S-3 to S-9, distinguishable from each other in their reactivity, appeared somewhat antigenically related. Their antigenic relatedness to the Norwal, Hawaii, and Otofuke agents was also examined by IEM by using antisera to these agents. S-3 appeared most closely related to the Norwalk agent. S-4 and S-5 were related to the Norwalk agent and, presumably, were distantly related to the Hawaii and Otofuke agents. S-6 and S-7 were related to the Hawaii and Otofuke agents. S-8 and S-9 were related to the Otofuke agent and, presumably, were distantly related to the Hawaii agent. The prevalence of each antigenic pattern in 38 outbreaks was examined: S-8 was implicated in 24% of the outbreaks S-5 in 16%, S-4 in 13%, S-9 in 13%, S-6 in 11%, and others in 5%.

[Clinical study on the use of retrograde cardioplegia with St. Thomas' Hospital solution]

One hundred and three consecutive patients with aortic valve disease and twenty seven patients with ischemic heart disease of severe critical coronary stenosis or left main trunk stenosis underwent open heart operations with the use of retrograde cardioplegic technique for myocardial protection. Under complete cardiopulmonary bypass, a balloon catheter was inserted into the coronary sinus through small right atriotomy and secured in place. Retrograde cardioplegia was accomplished using cold St. Thomas' Hospital solution by drip method at height of 60 to 80 cm with topical saline slush. Cardiac resuscitation was very easy and acceptable hemodynamics were obtained in all patients. Even in 8 patients in which aortic crossclamping time was above 180 minutes cardiac recovery was excellent except one who needed IABP support. Eight patients in aortotomy group were died postoperatively from the reasons unrelated to myocardial protection. Postoperative hemodynamic data and enzymatic analyses of CK-MB revealed good myocardial protective effects. Retrograde cardioplegia with the use of cold St. Thomas' Hospital solution is thus an effective alternative of myocardial protection in aortic valve surgery or aortotomy surgery and in coronary revascularization for multiple coronary stenoses or left main trunk lesions.

[Surgical treatment of impending rupture of aortic arch aneurysm associated with ischemic heart disease]

A 58-year-old man with thoracic aneurysm was admitted because of progressive chest oppression, back pain and the rapidly grown mediastinal mass lesion in his chest X-ray. Aortography and computed tomography revealed impending rupture of saccular aortic arch aneurysm. Emergency operation, consisted of aortic arch replacement under selective cerebral perfusion and CABG with the left IMA, was performed successfully. His postoperative course was uneventful without any neurological deficit. Postoperative angiography demonstrated successful reconstruction of the aortic arch and the patent IMA graft.

Optical computing using optical flip-flops in Fourier processors: use in matrix multiplication and discrete linear transforms

An architecture and the algorithms for matrix multiplication using optical flip-flops (OFFs) in optical processors are proposed based on residue arithmetic. The proposed system is capable of processing all elements of matrices in parallel utilizing the information retrieving ability of optical Fourier processors. The employment of OFFs enables bidirectional data flow leading to a simpler architecture and the burden of residue-to-decimal (or residue-to-binary) conversion to operation time can be largely reduced by processing all elements in parallel. The calculated characteristics of operation time suggest a promising use of the system in a real time 2-D linear transform.

Isolation and characterization of a novel growth hormone cDNA from chum salmon (Oncorhynchus keta)

A cDNA clone which codes for a novel growth hormone has been isolated from the library of chum salmon pituitaries. The clone encodes a polypeptide of 210 amino-acid residues including 22 amino-acid residues of signal peptide, which is identical in length with known chum salmon growth hormone. In the coding region, there are 30 base substitutions, some of which result in 12 amino-acid substitutions. There are 8 base changes in the 5' untranslated region, and large insertions/deletions are in the 3' non-coding region. These results clearly indicate that there are at least two species of mRNAs for growth hormone in chum salmon pituitary.

Molecular cloning and sequence analysis of chum salmon gonadotropin cDNAs

cDNAs encoding alpha and beta subunits of salmon gonadotropins, sGTHI and sGTHII, have been isolated from the cDNA library prepared from salmon pituitary mRNA. sGTHI alpha, sGTHI beta, and sGTHII beta cDNAs encode polypeptides of 114, 137, and 142 amino acids, including signal peptides of 22, 24, and 23 amino acids, respectively. The deduced amino acid sequence for sGTHI alpha revealed rather high homology (66-69%) to mammalian alpha chains, whereas sGTHI beta and sGTHII beta show lower homology (30%) to each other and to mammalian beta subunits. The existence of two distinct beta-subunit cDNAs in the teleost suggests that divergence of the GTH gene took place earlier than divergence of teleosts from the main line of evolution leading to tetrapods.

Outbreak of herpangina associated with Coxsackievirus B3 infection

An outbreak of acute febrile illness was observed in summer, 1987, in a welfare home in which 31 healthy infants were accommodated. Within a 5-day period 25 infants (81%) acquired a febrile illness. Coxsackievirus B3 was isolated from 16 (64%) of 25 throat swabs. In the patients in whom viral culture was negative or not performed, 6 were serologically identified as having a coxsackievirus B3 infection. Among 22 patients identified as having a coxsackievirus B3 infection 7 had typical herpangina and the others had pharyngitis with or without a few small vesicles. Serum alpha-interferon was detected in all but 2 cases (one with proved infection and another with indefinite infection). Herpangina can be associated with coxsackievirus B3 as well as with the more frequently associated coxsackievirus Group A; this explosive type of outbreak might be transmitted by a small particle aerosol.

Western blot (immunoblot) assay of small, round-structured virus associated with an acute gastroenteritis outbreak in Tokyo

Small, round-structured virus (SRSV) was detected in a stool specimen of a patient during an acute gastroenteritis outbreak in Tokyo and was tentatively named SRSV-9. SRSV-9 was purified by sucrose velocity gradient centrifugation after CsCl density gradient centrifugation. The buoyant density of SRSV-9 appeared to be 1.36 g/ml in CsCl. A Western blot (immunoblot) assay using the biotin-avidin system revealed that SRSV-9 was antigenically related to the Hawaii agent but distinct from the Norwalk agent and contained a single major structural protein with a molecular size of 63.0 +/- 0.6 kilodaltons. The prevalence of SRSV-9 infection in Tokyo was surveyed by the Western blot antibody assay by using a crude virus preparation as the antigen. Seroconversion was observed in 56.5% of the patients involved in the outbreaks from which SRSV was detected by electron microscopy.

Prevalence of small round structured virus infections in acute gastroenteritis outbreaks in Tokyo

During the three-year period from 1984 to 1987, 506 acute gastroenteritis outbreaks involving 14,383 patients were reported to the Bureau of Public Health, Tokyo Metropolitan Government. Eighty (4,324 patients) of 150 outbreaks (4,860 patients) from which etiologic agents were not identified were subjected to virological investigation. Spherical particles of 28-32 nm in diameter with capsomere-like structures on the surface were detected in patients' stool specimens. Buoyant density of the particles appeared to be 1.36 to 1.40 g/ml in CsCl. Seroconversion to the particles was observed in patients by immune electron microscopy. From these observations, we concluded that the detected particles were members of small round structured virus (SRSV), and that they were implicated in the etiologically ill-defined outbreaks encountered. Prevalence of SRSV infections in these outbreaks was examined by electron microscopy. SRSV was positive in 83.8% of the outbreaks, and 96.4% of the cases. SRSV-positive outbreaks usually occurred during winter in contrast to bacterial outbreaks which often occurred in the summer season. Of 80 outbreaks examined, 53 were associated with the ingestion of oysters, and the remaining 27 mostly with food other than oysters. Oyster-associated outbreaks usually occurred on a small scale, while unassociated ones on diverse scales ranged from family clusters to large outbreaks.

Mutagenesis of human granulocyte colony stimulating factor

To define the structure-function relationship, we have made a number of mutants of human granulocyte colony-stimulating factor (hG-CSF) by in vitro mutagenesis. The results indicate that most of the mutations located in the internal and C-terminal regions of the molecule abolished the activity, whereas the mutants without N-terminal 4, 5, 7, or 11 amino acids retained the activity. N-terminal amino acids were also altered by cassette mutagenesis using a synthetic oligonucleotide mixture. Among them, KW2228, in which Thr-1, Leu-3, Gly-4, Pro-5 and Cys-17 were respectively substituted with Ala, Thr, Tyr, Arg and Ser, showed more potent granulopoietic activity than that of intact hG-CSF both in vitro and in vivo.

[Transseptal suture fixation in the management of prosthetic valve dehiscence]

Valve dehiscence resulted from prosthetic valve endocarditis and aortitis is the most common cause of the reoperation after prosthetic valve replacement. In our experience, the results of reoperation has been far from satisfactory. For the successful management of prosthetic dehiscence, we have adopted the transseptal suture technique of accurately securing the prosthetic valve. Five patients with prosthetic valve dehiscence and one patient with native valve endocarditis were operated upon using the transseptal techniques. Left ventricular-aortic discontinuity was repaired using composite valve-tube graft together with this technique in two patients. All but one patient who succumbed to multiple organ failure induced by preoperative hemodynamic deterioration have survived the operation without recurrent infective endocarditis or valve dehiscence.

Molecular cloning of eel growth hormone cDNA and its expression in Escherichia coli

cDNA clones coding for growth hormone (eGH) of Japanese eel (Anguilla japonica) have been isolated from a cDNA library prepared from pituitary gland poly(A)+ RNA. The nucleotide sequence of the eGH cDNA was determined. It codes for the prehormone of 209 amino acids (aa) including a putative signal peptide of 19 aa. The deduced amino acid sequence was identical with that determined for eGH protein. The primary structure of eGH was compared with those of other species growth hormones (chum salmon, chicken, rat, and human). Mature eGH was expressed in Escherichia coli harboring a plasmid in which the eGH cDNA was under control of the phage lambda pL promoter. Recombinant eGH polypeptide was immunoreactive to rabbit antiserum against natural eGH. Furthermore, eGH derivative with amino-terminal deletion (delta 1-3 eGH) was produced in E. coli reaching up to 5% of total cellular proteins.

A gag-env hybrid protein of human T-cell leukemia virus type I and its application to serum diagnosis

A fused gene of the gag and env sequences of human T-cell leukemia virus type I (HTLV-I), the causative agent of adult T-cell leukemia, was constructed in vitro and expressed in Escherichia coli. The gag-env hybrid protein accumulated as insoluble granules with a yield of approximately 12% of the total proteins. In an enzyme-linked immunosorbent assay done with the use of the gag-env hybrid protein, all 57 seropositive sera gave positive signals, and none of the sera from normal persons did. This system can produce large quantities of the gag-env hybrid protein, which can be used for mass screening of human sera for HTLV-I infection.

[Enhancement of antitumor effect of MMC on Walker 256 by intra-arterial administration of noradrenaline in hyperthermia]

We performed a study of hyperthermia while injecting 0.05% of Noradrenaline following MMC for 10 minutes into the feeding artery of Walker-256 carcinosarcomas implanted 6 days earlier into the s.c. dorsum side of hindpaw of Wistar rats. The tumor growth rates on the 6th day after treatment by warning tumor in hot water (40 degrees C, 44 degrees C) for 10 minutes with or without Noradrenaline, were 0.7 +/- 0.6, 2.1 +/- 0.9 (40 degrees C) and 0.2 +/- 0.3, 0.0 +/- 0.0 (44 degrees C), respectively. The data suggested that tumor ischemia induced by a vasoconstrictive drug may enhance the antitumor effect in low grade warning therapy (40 degrees C). An injection of warmed physiological saline (50 degrees C) may heat the tumor vessels on the tumor surface and showed enhanced antitumor effects as a from of hyperthermia. The target area of the tumor for hyperthermia can be considered to be the tumor vessels on the tumor surface.

[Enhancement of Walker-256 antitumor effect by intra-arterial administration of TNF before using mitomycin C]

Intraarterial administration of TNF showed enhanced antitumor effects on Walker-256 implanted in the dorsum side of the Wistar rat hindpaw than by its intravenous injection. Using MMC immediate after TNF can have an improved antitumor effects.

Cloning of granulocyte colony-stimulating factor cDNA from human macrophages and its expression in Escherichia coli

Human granulocyte colony-stimulating factor (hG-CSF) cDNA was cloned, by using a synthetic oligonucleotide probe, from an Okayama-Berg cDNA library of lipopolysaccharide-stimulated human peripheral blood macrophages. The cDNA encodes a polypeptide with an amino acid sequence which completely matches that of the known polypeptide with hG-CSF activity derived from human tumor cell lines. Expression in E. coli of high levels of the protein (about 10% of total cellular proteins) was accomplished under control of the trp promoter, and the purified protein was proved to have hG-CSF activity. Our data provide evidence that human peripheral blood macrophages do produce hG-CSF mRNA when stimulated exogenously, suggesting they are the producer of naturally occurring hG-CSF.

[Thermochemotherapy of unresectable pancreatic carcinoma (hot water and intra-arterial chemotherapy using noradrenaline)]

A 86-year-old man with unresectable pancreatic carcinoma was treated with thermochemotherapy. In most of the body and tail affected by the tumor, which did not show any cytotoxic damage after intraarterial chemotherapy, an enhanced antitumor effect was achieved by hyperthermia, which heated the tumor using hot water in a balloon placed on the pancreas, and which was delivered through a vinyl tube leading out of the body for 40 minutes while administration of antitumor agents mixed with noradrenaline was simultaneously given into the celiac artery. In this case, we observed that using noradrenaline with contrast material injected into the celiac artery it was possible to delineate the tumor area by computed tomography of the pancreas.

A serological survey for human immunodeficiency virus types 1 and 2 of individuals who visited health centers in Tokyo

The serum antibodies to human immunodeficiency virus types 1 (HIV-1) and 2 (HIV-2) were examined for among individuals who visited health centers in Tokyo. Of 8,198 sera screened, one was true-positive and 37 false-positive for HIV-1 antibodies. These 37 false-positives and 305 sera from the population groups at risk for HIV-2 (42 sojourners in Africa, 251 homo- and bisexuals, and 19 prostitutes) were further examined for HIV-2 antibodies by indirect immunofluorescence and Western blotting. No antibodies reactive with HIV-2 were detected in the sera examined. Serological cross-reactivity between HIV-1 and HIV-2 was examined by use of rabbit antisera.