Binding of influenza type A viruses to group B Streptococcus and haemagglutination by virus-bound bacteria

We studied the bindings of human influenza A type viruses to group B Streptococcus (GBS), types Ia, II, III and IV, of sialic acid (SA)alpha2-3 linkage, using A/PR/8/34(H1N1) and A/Memphis/1/71(H3N2). The viruses were found to bind to all types of GBS, with the exception of PR/8/34 for GBSII, and to elute from GBSIa, III and IV at 37 degrees C, except GBSII. Electron microscopy confirmed these behaviours of the influenza viruses. The virus-binding capability of GBS types seemed to depend on the side chain length of the terminal SA. Treatment of GBSIa, III and IV, except enzyme-resistant type II, with bacterial neuraminidase resulted in the loss of virus-binding capability of GBS. These findings confirmed that SAalpha2-3 linkage of GBS capsules functions as receptor for human influenza viruses. When singular bacteria were prepared from mainly chain-like GBS with sonication, viruses were found to bind to them more efficiently. Untreated and sonicated GBS were both aggregated with high doses of virus. Furthermore, using A/Memphis/1/71(H3N2) and GBSII, we found that virus-bound GBS, untreated or sonicated, caused haemagglutination (HA). The morphological evidence that chicken erythrocytes were bridged with virus-bound native GBSII, supporting occurrences of HA, was obtained. Statistical analysis suggested that HA by virus-bound sonicated (singular) GBS was mediated by bacteria bound by at least two or three virus particles.

Peritoneal washings cytology combined with immunocytochemical staining in pancreatic cancer

BACKGROUND/AIMS

Peritoneal washings from patients with pancreatic cancer demonstrate malignant cells in 0-58% of patients. But the significance of their potential for implantation and growth after radical surgery has not been clarified.

METHODOLOGY

Peritoneal washings were collected from 74 consecutive pancreatic cancer patients during a 5-year period and studied by conventional staining and immunocytochemical staining using anti-CEA and anti-CA 19-9. Fifty of the 74 patients were resectable and the others were nonresectable.

RESULTS

Seven out of 8 patients with macroscopic peritoneal metastasis were positive in conventional staining, but all 8 patients were positive in immunocytochemical staining. Five of the 66 (8%) patients without macroscopic peritoneal metastasis were positive in conventional staining, but the positive rate increased to 14 of 66 (22%) in immunocytochemical staining. There was no statistically significant difference in post-operative cumulative survival rate between the 13 positive cytology patients and 37 negative cytology patients without macroscopic peritoneal metastasis.

CONCLUSIONS

The positive rate of peritoneal washings cytology was increased in this study by the use of immunocytochemical staining in addition to conventional staining. No statistically significant difference in post-operative cumulative survival rate between positive cytology patients and negative cytology patients without macroscopic peritoneal metastasis was observed.

Molecular recognition of adenophostin, a very potent Ca2+ inducer, at the D-myo-inositol 1,4,5-trisphosphate receptor

The recognition mode of adenophostin A at the D-myo-inositol 1,4, 5-trisphosphate [Ins(1,4,5)P(3)] receptor was investigated. Comparison of conformations of Ins(1,4,5)P(3) and adenophostin A by using the combination of NMR and molecular mechanics (MM) calculations demonstrated that adenophostin A adopted a moderately extended conformation regarding the distance between the 2'-phosphoryl group and the 3' ',4' '-bisphosphate motif, as suggested previously [Wilcox, R. A. et al. (1995) Mol. Pharmacol. 47, 1204-1211]. Based on the nuclear Overhauser effect (NOE) observed between 3'-H and 1' '-H and on MM calculations, the molecular shape of adenophostin A proved to be an extended form at least in solution, in contrast to Wilcox's compactly folded, preliminary hairpin model. GlcdR(2,3',4')P(3), an adenophostin analogue without adenine moiety, was found to be less potent than adenophostin A and almost equipotent to Ins(1,4,5)P(3). We propose the possibility that (i) the optimal spatial arrangement of the three phosphoryl groups and/or (ii) the interaction of the adenine moiety of adenophostin A with the putative binding site, if it exists in the vicinity of the Ins(1,4,5)P(3)-binding site, might account for the exceptional potency of adenophostin A.

Advanced onset of menarche and higher bone mineral density depending on vitamin D receptor gene polymorphism

Bone mineral density (BMD) at distal forearm, and weight and height of healthy Japanese girls aged 18-19 years were measured and their age at menarche was obtained through a questionnaire. A statistically significant association was found between BMD at distal radius and vitamin D receptor (VDR) gene polymorphism at the ApaI site. The age at menarche in the population with Aa genotype was significantly earlier than that in the aa population. In addition, BMD was significantly dependent on the earlier onset of menarche in the population with genotype Aa but not in the population with genotype aa. BMD was also positively associated with the body mass index (BMI) in the population with genotype Aa. Statistical analysis suggested a stronger effect of VDR genotype on age at menarche than on BMI. Thus, we show that VDR gene polymorphism advances the age at menarche and increases BMD in cooperation with age at menarche.

Alteration of the properties of gastric smooth muscle in the genetically hyperglycemic OLETF rat

Membrane responses were recorded from isolated gastric smooth muscle of Otsuka Long-Evans Tokushima Fatty (OLETF) and Long-Evans Tokushima Otsuka (LETO) rats, using microelectrode techniques. At the age of 68-76 weeks, the blood sugar level was 181 mg/dl in LETO rats and 350 mg/dL in OLETF rats. In both rats, the membrane potential was stable in fundus muscle and spontaneously active with generation of slow waves in antrum muscle. The resting membrane potential was about - 46 mV in fundus and - 55 mV in antrum muscles of LETO rats, and the values were 3-7 mV lower in OLETF rats. The slow waves were generated regularly in LETO rats, while they were irregular and of small amplitude in OLETF rats. Transmural nerve stimulation evoked a cholinergic excitatory junction potential and following inhibitory junction potential in LETO rats, and only an inhibitory junction potential of smaller size was generated in most of OLETF rats. The acetylcholine-induced depolarization was greater in OLETF than in LETO rats. The level of hyperpolarization produced by noradrenaline was similar between OLETF and LETO rats. Thus, the reduction of the resting membrane potential, weakening of spontaneous activity, impairment of cholinergic transmission and cholinergic supersensitivity were associated with hyperglycemia. These alterations were considered due to the development of diabetes mellitus.

Changes in phenytoin concentrations in blood and cerebrospinal fluid caused by direct hemoperfusion in a patient intoxicated with phenytoin

We performed direct hemoperfusion (DHP) 5 times on a patient with consciousness disorder and phenytoin intoxication. We then measured the phenytoin concentrations in her cerebrospinal fluid (CSF) and blood at various times. After the first DHP session, consciousness began to improve, and it normalized after the fourth DHP session when the blood concentration of phenytoin had decreased from 54.0 microg/ml to 16.5 microg/ml. The average plasma phenytoin elimination rate of DHP was 18.0% over 120-180 min. The concentration of phenytoin in the CSF decreased as that in the blood was lowered by DHP. The average reduction rate of phenytoin in the CSF after a DHP session was 23.7%, which was similar to the rate of elimination from the blood. The CSF/blood phenytoin ratio was 0.17, and no marked changes were detected before or after a DHP session.

Spontaneous healing of pancreatic abscess after fistulization to the duodenal bulb

A 70-year-old man was admitted to the hospital because of sudden, upper abdominal and back pain. Laboratory and image data indicated acute pancreatitis. Shortly after the admission, pancreatic and liver abscess with bacteremia developed. Antibiotic therapy seemed effective. A month later, spontaneous fistulization of the pancreatic abscess to the duodenal bulb was found by gastroduodenal fiberscopy. Injection of contrast medium into the duodenal orifice showed that the fistula was draining the abscess and that no other fistula formed from the abscess. Endoscopic retrograde cholangiopancreatogram indicated no fistula formation to the pancreatic duct. The pancreatic abscess became smaller and was not visible using computerized tomography and ultrasonography 3 months later and thereafter. Closure of the duodenal orifice was ascertained by the endoscopy. It is suggested that retrograde infection from the fistula was prevented by the single fistulization to the acidic duodenal bulb, which is not supposed to allow most bacterial growth. Pancreatic abscess usually necessitates operative treatment, even with fistulization to the alimentary tract. It seems likely that the single, small fistulization to the bulb, in addition to the lack of underlying disease and medical and nutritional support, facilitated the spontaneous healing process.

[A case of non-smoking female with peripheral small lung squamous cell carcinoma discovered after operation of spontaneous pneumothorax]

We have experienced a lung cancer patient discovered after operation of pneumothorax by chance. The patient was 44-year-old female who had been followed up for right pneumothorax in menstruation. She got pneumothorax in menstruation recurrently complained of chest pain. Chest X-p revealed right pneumothorax. We never discovered views of catamenial pneumothorax by thoracoscopy. Partial resection of hypertrophic pleura of right S1 was performed by video assist thoracoscopic surgery. Histological diagnosis was bulla formation with a tiny focus of squamous cell carcinoma in situ. In addition, right upper lobectomy and lymph node dissection were performed. Metastasis was not recognized any lymph node. No recurrence has been observed for 17 months.

[Combined surgery for coronary artery disease and thoracic aortic disease]

Combined surgery in 6 cases who had coronary artery disease and thoracic aortic disease simultaneously was analyzed. Case # 1 had ascending aortic replacement under deep hypothermic circulatory arrest because of iatrogenic aortic dissection caused by aortic clamp during the routine coronary artery bypass grafting (CABG). Case # 2 had DeBakey type II chronic dissection. Case # 3 had type I aortic dissection 4 years after the initial CABG. Both case # 2 and # 3 had ascending aortic replacement under retrograde cerebral perfusion along with CABG. Transverse aortic replacement was performed in case # 4, # 5 and # 6 under selective cerebral perfusion along with CABG. Case # 4 was associated with ascending-transverse aortic aneurysm. Case # 5 had aortitis syndrome complicated with severe coronary ostial stenosis and cervical branch stenosis. Case # 6 also had aortitis syndrome, severe coronary ostial stenosis, heavily calcified ascending-transverse aorta, and mitral and aortic regurgitation. This case had mitral and aortic valve replacement additionally. Case # 2 died of low cardiac output syndrome and multi-organ failure postoperatively. Case # 4 did not recover from profound shock that followed the preoperative acute myocardial infarction. The problems of low cardiac output syndrome caused by long interval of ischemic cardiac arrest, and also the problems of proximal anastomotic site of saphenous vein grafts were discussed.

Porphyrobacter tepidarius sp. nov., a moderately thermophilic aerobic photosynthetic bacterium isolated from a hot spring

A new thermophilic bacterium, strain OT3T (T = type strain), was isolated from a brackish hot spring. Strain OT3T is an obligate aerobe that synthesizes bacteriochlorophyll a and has a photosynthetic apparatus. This isolate is a thermophilic bacterium with an optimal growth temperature of 40 to 48 degrees C. The cells are nonmotile, ovoid to short rods. An analysis of 16S rRNA sequences revealed that the new strain forms a coherent cluster with members of the alpha-4 group of the alpha subclass of the Proteobacteria, which contains the genera Erythrobacter, Erythromicrobium, and Porphyrobacter. The closest relative is Porphyrobacter neustonensis, with a 16S rRNA sequence similarity of 96.8%. The in vivo absorption spectrum has maxima at 460, 494, 596, 800, and 870 nm. The main carotenoids are OH-beta-carotene sulfate derivatives, nostoxanthin, and bacteriorubixanthinal. Growth occurs with glucose, acetate, glutamate, butyrate, Casamino Acids, and yeast extract as sole energy sources. The pigment composition and nutritional profile of the new isolate are similar to the pigment composition and nutritional profile of P. neustonensis. Although there are marked differences in cell morphology between the new isolate and the budding bacterium P. neustonensis, the results of phenotypic and genetic comparisons suggest that the new isolate is closely related to P. neustonensis. Consequently, we assign the new isolate to the genus Porphyrobacter and propose the name Porphyrobacter tepidarius sp. nov. for it; the type strain of P. tepidarius is strain OT3 (= DSM 10595).

[A case of ventricular septal perforation treated surgically with an infarction exclusion technique]

We report an 85-year-old woman with postinfarction interventricular septal perforation. She underwent successful emergent surgical treatment by a slightly modified method based on David-Komeda's procedure. Perforation in this case occurred four days after acute myocardial infarction. Preoperative Qp/Qs was 2.58, and pulmonary artery pressure was 34/25 mmHg. The area of infarction was large, and the perforation was the linear type 2.5 cm long near the apex. A probe was not able to pass through the perforation due to its complicated configuration. A double Xenomedica patch was sutured on the left side of the interventricular septum without excising the infarcted area. The suture line was placed on healthy myocardium apart from the infarcted area. The Xenomedica patch was sandwiched between the closure line of the ventriculotomy. Four days after surgery, residual shunt was observed by echocardiogram, but this subsequently disappeared on the 17th postoperative day. The patient was discharged from our hospital on the 57th postoperative day, and is now doing quite well.

Physiological changes during acute obstruction of the superior vena cava, azygos, and internal thoracic veins in dogs

PURPOSE

In the surgery for superior vena cava (SVC) reconstruction, the cross-clamping of the SVC may cause brain damage. Experimental study was performed to clarify the safe limit of the clamping time and the appropriate monitoring method during the surgery.

METHODS

In anesthetized dogs, the internal thoracic and azygos veins were ligated, and the SVC was clamped for 120 min. Arterial blood pressure, intracranial venous pressure, regional cerebral blood flow, and electroencephalogram were monitored in six dogs. Somatosensory evoked potentials were recorded in one other dog, and in another dog postoperative neurological changes were evaluated for 3 weeks. The brains of the dogs were subjected to the histological examination including tetrazolium stain.

RESULTS

The arterial blood pressure decreased and the intracranial venous pressure increased during the clamping. Oscillation of the pressure was noted at 45 to 74 min after clamping. The regional cerebral blood flow was 57.4 ml/100 g/min on average before clamping, and decreased to 15.5 ml/100 g/min at 105 min after clamping. The electroencephalogram demonstrated no pronounced change during clamping, but the amplitude of the somatosensory evoked potentials decreased and the latency was prolonged during clamping. No neurological defect was noted in the dog observed for 3 weeks. All areas of the brain showed staining with the tetrazolium, indicating intact mitochondria. The microscopic findings for the brains included no marked changes.

CONCLUSION

The SVC clamping for 120 min was tolerated by the dogs, and the most reliable monitoring method was concluded to be the recording of somatosensory evoked potentials.

Rounded atelectasis formation following decrease of pleural effusion: a case report

We present a case of rounded atelectasis (RA) observed continuously following decrease of pleural effusion. The collapsed right lower lobe adjacent to pleural effusion changed its shape from wedge-shaped consolidation with air-bronchogram to oval and flat formation at last. The vessels and bronchi curving into RA were detected by CT and we called it horizontal comettail sign. When a mass is detected following decrease of pleural effusion and vessels and bronchi are curving into the mass, the mass may be diagnosed as RA and no further examination may be necessary.

CT-pathologic correlation in the tumor margins of lung cancer

A CT-pathologic correlative study concerning the nature of the tumor margin was performed in 22 lung cancer cases with solitary nodules in the peripheral lung field. Three of 14 adenocarcinoma cases showed an ill-defined margin and an adjacent subtle high attenuation area on CT, representing alveoli lined by tumor cells. In the other 11 cases, both ill- and well-defined margins were seen on CT. A well-defined margin of the mass represented alveoli filled entirely with mucinous material or tumor cells. In three of six squamous cell carcinomas an ill-defined margin in CT represented the infiltration of lymphatic cells surrounding the tumor and continuous spread of tumor cells from neighboring alveoli. A well-defined margin in the other cases and two small cell carcinoma cases represented alveoli filled entirely with tumor cells. CT was shown to be very useful in the assessment of the nature of the margin of the tumor.

Septal structure of incomplete interlobar fissures of the lung

RATIONALE AND OBJECTIVES

Some septal structures have been observed in the areas of incomplete interlobar fissures (IIFs) in resected lungs. We describe the anatomy of IIFs with or without the presence of septal structures.

METHODS

Twenty fused areas from 16 autopsy cases were examined histologically. Other septal structures outside the areas of IIFs also were examined.

RESULTS

In 10 of the 20 fused areas, there was a mixture of septal structures with and without defects. In the remaining 10, there were no septal structures. The septal structures consisted of two inner layers from both lobes. Other septal structures examined were the same as ones observed in the IIFs.

CONCLUSION

Linear shadows seen at interlobar fissures and on computed tomography scans do not necessarily depict the presence of complete interlobar fissures. The absence of linear shadows does not necessarily imply the absence of septal structures.

Regular and irregular dichotomies of bronchial branching in the human lung

RATIONALE AND OBJECTIVES

Typical models of the human bronchial tree depict regular branching. However, some anatomic studies also have revealed irregular dichotomies in the human lung. We therefore studied the patterns of bronchial branching in the human lung.

METHODS

We examined a normal right lung. Bronchial branchings were traced up to terminal bronchioles (TBs) in both regular and irregular dichotomies.

RESULTS

In 256 TBs in peripheral regions, the number of branchings varied from 11 to 23; the largest number was found in the S10c of the basal segment, and the average was 15. In 354 TBs in hilar regions supplied by irregular dichotomies, the number of branchings ranged from 9 to 15, with the average being 10. In secondary pulmonary lobules, bronchioles supplying the secondary pulmonary lobules reached TBs in two or three divisions.

CONCLUSION

Irregular dichotomies are too frequent to be neglected in the interpretation of radiologic and physiologic findings.

[Coronary artery bypass grafting for acute myocardial infarction]

Five hundred and fourteen cases with acute myocardial infarction were admitted to our hospital during the past 5 years, since April 1990. Among 343 cases who had emergency coronary angiography, 53 cases had coronary artery bypass grafting surgery within 2 weeks after the onset of acute myocardial infarction. Mean number of bypass grafts was 2.9 +/- 0.9/patient, and operative mortality was 25% (13/53). Clinical condition immediately before the surgery and surgical mortality was, shock state in 20 cases (mortality 50%), IABP dependent state in 23 cases (mortality 13%), post-infarction angina in 8 cases (mortality 0%). Mortality in 8 cases whose infarct-related artery was left main trunk was as high as 63%. Eight of 9 cases whose cardiac indices were below 2.01/min/m2 immediately after the surgery died of pump failure. On the contrary, only 2 of 37 cases whose post-operative cardiac indices were above 2.01/min/m2 died of non-cardiac reason. To improve the surgical results, we concluded that powerful mechanical support such as ventricular assist system should be applied to post-operative pump failure cases whose cardiac indices were below this limit despite the aid of IABP.

[Comparison between high-resolution computed tomography and 99mTc-technegas SPECT pulmonary emphysema]

Scintigraphy with 99mTc-technegas was recently introduced for clinical imaging of lung ventilation. This method has been found to be useful in emergencies, to be more suitable for single photon emission computed tomography (SPECT) than other agents used in ventilation scintigraphy, and could reveal abnormalities in ventilation more easily than high resolusion computed tomography (HRCT) in pulmonary emphysema. We compared 99mTc-technegas SPECT with HRCT in six regions: the right upper, middle, and lower lobes, the left upper lobe, the lingula, and the left lower lobe, in 15 patients with pulmonary emphysema. Patients with centrilobular emphysema tended to show stronger changes in upper lobes than in lower lobes on both 99mTc-technegas SPECT and HRCT. Some regions showed no change on HRCT but various changes on 99mTc-SPECT. Patients with panlobular emphysema showed severe changes on 99mTc-SPECT in lower lung fields in which well-demarcated areas of low attenuation were not seen on HRCT. We conclude that 99mTc-SPECT is useful for detecting early changes and panlobular changes in pulmonary emphysema.

[Surgical results of total replacement of aortic root]

Total aortic root replacement was performed on 19 cases since December 1979 to May 1995. They were devided in two groups. First 7 cases were operated by original Bentall procedure with inclusion technique (group A). Succeeding 12 cases were operated by Carrel patch method or Cabrol procedure without inclusion maneuver. There were 2 operative deaths in group A (28.6%) and was one death in group B (8.3%) respectively. The operation time and the extracorporeal circulation time were significantly shorter in group A than that in group B. Anastomotic leakage was noted in 2 cases of group A. One of them required reoperation and another one with coronary ostial leakage died of congestive heart failure. We concluded that non-inclusion method for aortic root replacement was superior to conventional inclusion technique and reimplantation of both coronary ostia with Carrel patch method was the best tactics especially for Marfan syndrome in terms of long term results.