Properties of the mouse cone-mediated electroretinogram during light adaptation

Cone-mediated electroretinograms (ERGs) were obtained from normal mice during the course of light adaptation to a rod-desensitizing adapting field. Responses obtained during the early minutes of light adaptation were smaller in amplitude, and delayed in implicit time in comparison to responses obtained to the same stimulus presented later during light adaptation. These changes resemble those observed in the human cone ERG obtained under similar stimulus conditions, and indicate that the underlying mechanism may be similar. While the use of an adapting field appears to isolate the mouse cone ERG, these adaptation-induced changes should be considered when evaluating this response.

Acid-induced unfolding and refolding transitions of cytochrome c: a three-state mechanism in H2O and D2O

Whereas the salt-dependent conformational transition of acid-denatured horse ferricytochrome c at pH 2 is approximated by a two-state mechanism from the acid-unfolded state to the molten globule state [Kataoka, M., Hagihara, Y., Mihara, K., & Goto, Y. (1993) J. Mol. Biol. 229, 591-596], the corresponding transition in D2O has been proposed to involve a noncompact, alpha-helical intermediate state (the pre-molten globule state) [Jeng, M.-F., & Englander, S. W. (1991) J. Mol. Biol. 221, 1045-1061]. To examine the proposed difference in the conformational transitions, we carried out the HCl and DCl titrations of cytochrome c in H2O and D2O, respectively, measured by far-UV circular dichroism, tryptophan fluorescence, and Soret absorption. In both D2O and H2O, unfolding from the native state to the acid-unfolded state and subsequent refolding to the molten globule state were observed. In either solvent, the conformational transitions were well approximated by a minimal three-state mechanism consisting of the native, molten globule, and acid-unfolded states. Thus, our results did not substantiate the presence of a pre-molten globule state in D2O. Acetylation of amino groups of cytochrome c is known to stabilize the molten globule state at pH 2. On the basis of the three-state mechanism, we constructed a conformational phase diagram for the effect of pH and the degree of acetylation. This phase diagram was similar to that of the pH- and salt-dependent conformational transition of cytochrome c, suggesting that the effects of acetylation on the conformational states are similar to those of salt.

[A case of cytomegalovirus pneumonia and Pneumocystis carinii pneumonia with lung cancer--diagnosis by the polymerase chain reaction]

A 64-year-old male was admitted to Oita Medical University Hospital because of primary lung cancer. After the anticancer chemotherapy, the patient developed a high fever. His chest X-ray showed diffuse reticular shadows bilaterally, which were considered to be a drug induced pneumonia, then pulse therapy with corticosteroid was performed. With this treatment, the diffuse reticular shadows disappeared. One month later, however, a severe interstitial pneumonia developed, and the patient died of respiratory failure. Autopsy findings demonstrated cytomegalovirus (CMV) and Pneumocystis carinni pneumonia. The polymerase chain reaction (PCR) for CMV in mononuclear cells in the blood was positive through out his hospitalization. In the sera, however, it was negative at the time of admission, then became positive 10 days before the onset of pneumonia. In addition, the PCR for P. carinni on the swab became positive as well. These results imply that PCR can be used for diagnosis of CMV and P. carinii infections from sera or swabs.

Brain energy metabolism and blood flow during sevoflurane and halothane anesthesia: effects of hypocapnia and blood pressure fluctuations

The effects of halothane and sevoflurane on cat brain energy metabolism and regional cerebral blood flow (rCBF) were evaluated during normo- and hypocapnia. Brain energy status was evaluated with phosphorous nuclear magnetic resonance spectroscopy (31P-MRS) and rCBF was measured by the hydrogen clearance method. A high concentration of halothane (3 MAC) impaired brain energy metabolism, while even a higher concentration of sevoflurane (4 MAC) had no untoward effect on brain energy metabolism. At 3 MAC of halothane, there were measurable decreases in brain phosphocreatine (69% of the control) and increases in brain inorganic phosphate (about 250% of control Pi), even though CBF was about 70% of the control value. During hypocapnia, the phosphocreatine levels began to decrease at a PaCO2 of 2.7 kPa with 2 MAC of sevoflurane (90% of the control), and at a PaCO2 of 4.0 kPa with 2 MAC of halothane (92% of the control). rCBF had decreased to less than 50% of the control value when PaCO2 was < or = 2.7 kPa with 2 MAC of sevoflurane and < or = 4.0 kPa with 2 MAC of halothane. Abnormal brain energy metabolism was only observed when rCBF was decreased to less than half of the control (non-anesthetized and normocapnic) value. Following administration of a vasopressor, metaraminol, the abnormal brain energy metabolism induced by 2 MAC of halothane at a PaCO2 of 1.33 kPa was normalized in parallel with the improved rCBF values. We conclude that hyperventilation and fluctuating blood pressure contribute to the occurrence of abnormal brain energy metabolism during halothane and sevoflurane anesthesia. This is more pronounced with halothane than with sevoflurane.(ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous determination of glucose and 1-deoxyglucose in serum by anion-exchange chromatography with an immobilized pyranose oxidase reactor

A liquid chromatographic system for the determination of glucose and 1-deoxyglucose in serum using an immobilized pyranose oxidase reactor and chemiluminescence detection is described. Separation was achieved on a TSK gel SAX column (2 cm x 4 mm I.D.) with an eluent of 0.1 M sodium hydroxide solution. Serum was diluted 30-fold with 0.1 M NaOH. Sample solution (50 microliters) was injected into the system. The hydrogen peroxide produced was detected by measuring the chemiluminescence emitted on admixing with luminol and potassium hexacyanoferrate (III). The calibration graphs were linear from 1 to 600 microM glucose and from 0.6 to 400 microM 1-deoxyglucose; the detection limits for glucose and 1-deoxyglucose were 0.5 and 0.3 microM, respectively. The sample throughput was 10/h. The immobilized enzyme reactor was stable for at least 2 months.

Intermediate conformational states of apocytochrome c

Horse apocytochrome c has been assumed to be a typical unfolded protein. At low ionic strength, the far- and near-UV circular dichroism spectra are typical of an unfolded protein at all pH values between 2 and 9. On the other hand, in the presence of high concentrations of salt, substantial secondary structure is present at both neutral and acidic pH. At low pH, perchlorate anion, either from salt or from acid, stabilizes an intermediate state (the A state) with secondary structure similar to that previously observed in the molten globule state of holocytochrome c. To further characterize the conformational states of apocytochrome c as a function of pH and salt, a fluorescence-labeled derivative was prepared, in which the two cysteine residues were labeled with N-(iodoacetyl)-N'-(5-sulfo-1- naphthyl)ethylenediamine(IAEDANS). The conformational transitions of the fluorescence-labeled apocytochrome c measured by circular dichroism were similar to those of unmodified apocytochrome c, indicating that the effects of the modification on the conformation and stability are small. Fluorescence energy transfer from tryptophan to the fluorescence label revealed several salt- and pH-dependent transitions. At very low ionic strength, apocytochrome c became compact as the pH was increased with a transition midpoint at pH 4.5. At acidic pH, increasing concentration of perchlorate induced a more compact state with a transition midpoint similar to that observed by circular dichroism. In contrast, at neutral pH, increasing perchlorate concentration had little effect on the compactness, as determined by a lack of change in the energy-transfer efficiency (but did increase the amount of secondary structure).(ABSTRACT TRUNCATED AT 250 WORDS)

An A-to-G transition at nucleotide pair 11084 in the ND4 gene may be an mtDNA polymorphism

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Mammary tumour induction by pituitary grafting in male mice: an animal model for male breast cancer

Isologous anterior pituitary grafting, 4 each, to 3-4-month-old SHN and SLN male mice resulted in an appearance of mammary tumours from 8 months of age and the incidence at 12 months reached 53.8% in each strain. All tumours were diagnosed as type B adenocarcinomas. In association with the results, normal mammary gland growth and mouse mammary tumour virus (MMTV)-gp52 antigen levels in the submaxillary glands were stimulated by the treatment in these strains. The effect of pituitary grafting was much less in GR/A male mice in which no mammary tumours appeared.

[Noninvasive assessment of left internal thoracic artery graft patency using transthoracic echocardiography]

To evaluate the utility of transthoracic echocardiography (TTE) for assessing the long-term patency of left internal thoracic artery (LITA) grafts, 36 patients who had coronary artery bypass grafting (CABG) were examined simultaneously for graft flow velocity by TTE and by graft angiogram. The flow velocity in the LITA graft was clearly visualized by TTE in 25 patients from the left supraclavicular echo view. On the basis of the angiogram, the sensitivity and specificity of TTE in the diagnosis of LITA graft patency were 71.4% and 100%, respectively. These 25 patients (mean follow-up time after CABG-29.6 months) were divided into 3 groups according to their preoperative diagnosis and the presence of grafts stenosis by angiogram as follows: APS(-), angina pectoris without graft stenosis in 15 cases; APS(+), angina pectoris with graft stenosis in 2 cases; OMI, old myocardial infarction without graft stenosis in 8 cases. The peak flow velocity D/S ratio and time velocity integral D/S ratio in the APS(-) group (2.48 +/- 0.73, 3.21 +/- 0.89) were significantly (p < 0.01) higher than those in the APS(+) group (0.30 +/- 0.23, 0.35 +/- 0.21) or in the OMI group (0.96 +/- 0.44, 0.87 +/- 0.51). Peak flow velocity D/(S+D) and time velocity integral D/(S+D) ratios in the APS(-) group (0.70 +/- 0.05, 0.75 +/- 0.06) were significantly (p < 0.01) higher than those in the APS(+) group (0.22 +/- 0.14, 0.25 +/- 0.11) or in the OMI group (0.46 +/- 0.17, 0.43 +/- 0.18).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the cardiac force-time integral with energetics using a cardiac muscle model

Several investigators have found experimentally that the force-time integral varies non-linearly with energy expenditure over the course of a cardiac contraction. Also, recent research findings have indicated that the crossbridge cycle to ATP hydrolysis ratio in muscle fiber systems may not be coupled with a one-to-one ratio. In order to investigate these findings, Huxley's sliding filament crossbridge muscle model coupled with parallel and series elastic components was simulated to examine the behavior of the crossbridge energy utilization and force-time integral vs time. Crossbridge (CB) energy utilization was determined by considering the ATP hydrolysis for the crossbridge cycling, and this CB energy was compared with the force-length energy in a contraction. This CB energy was calculated in both isometric and isotonic contractions as a function of contraction time and compared to the force-time integral. Simulation results demonstrated that the ratio of the force-time integral to CB energy varies strongly throughout the cardiac cycle for both isometric and isotonic cases, as has been observed experimentally. Simulations also showed that using the force-length energy component of energy vs the CB energy gave a better correlation between the total energetic predictions and the force-time integral, agreeing with recent finding that the crossbridge cycle to ATP hydrolysis ratio may not be coupled one-to-one, especially at lower force levels.

Ejecting deactivation does not affect O2 consumption-pressure-volume area relation in dog hearts

We studied the effects of ejection velocity and resistive properties of the left ventricle (LV) on myocardial oxygen consumption (VO2) in 13 excised cross-circulated dog hearts. Increases in peak ejection velocity (-dV/dt) from 4.0 +/- 1.3 (SD) end-diastolic volume (EDV)/s to 12.7 +/- 5.3 EDV/s with constant EDV and end-systolic volume (velocity run) induced systolic pressure deficit. This decreased pressure-volume area (PVA; a measure of ventricular mechanical energy) and LV end-systolic elastance (Emax) by 47 +/- 14 and 38 +/- 15%, respectively. Unchanged maximum rate of left ventricular pressure rise and time-varying elastance during the isovolumic contraction period at the same EDV indicated that these contractions started with the same contractile state although the quicker ejection caused the greater deactivation. If the PVA deficit due to systolic pressure deficit is attributable to an internal energy-dissipating resistive element, VO2 in the velocity run will not as much decrease in proportion to PVA as in the isovolumic or slowly ejecting control run. However, the decreases in PVA due to increased -dV/dt decreased VO2 to the same extent as in the control run. This result negated the possibility that the pressure and PVA deficits would be caused by a mechanical energy-losing process. The same results were obtained whether or not Emax was decreased by quick ejection. We conclude that the pressure and PVA deficits and the proportionally decreased VO2 during quick ejection are mainly attributable to suppression of a ventricular mechanical energy generation process, but not of mechanical energy-losing process, by ejecting deactivation.

[Adult respiratory distress syndrome due to sepsis caused by Staphylococcus aureus: a case report]

A 59-year-old man, under treatment for osteoarthritis of the right hip joint, was admitted to the Department of Orthopedic Surgery of Health Insurance Nankai Hospital with complaints of high fever and severe right hip joint pain. Since he developed shock, he was transferred to the Department of Internal Medicine. The laboratory data showed marked increase of acute phase reactants, and Staphylococcus aureus was cultured from the abscess in the right hip joint. The chest X-ray film the next day showed diffuse pulmonary edema of both lungs. The diagnosis of adult respiratory distress syndrome (ARDS) due to sepsis caused by S. aureus was made. Septic ARDS due to S. aureus is rare. The patient was cured by mechanical ventilation and administration of antibiotics, methyl-prednisolone and Urinastatin, along with drainage of the abscess in the right hip joint.

[A patient with lysosomal glycogen storage disease with normal acid maltase]

A 13-year-old boy with mental retardation developed idiopathic cardiomyopathy and glycogen storage myopathy, but with normal lysosomal enzyme activities, consistent with a syndrome of lysosomal glycogen storage disease with normal acid maltase coined by Danon et al (1981). He was in good health except for WPW syndrome diagnosed at 7 years of age. He had heart murmur with abnormal ECG, elevated serum GOT, GPT, LDH, CK and aldolase levels. An echocardiogram showed obstructive hypertrophic cardiomyopathy. Lysosomal enzyme activities including acid alpha-glucosidase in fibroblasts were within normal limits. In the biopsied biceps brachii muscle, there was a mild variation in fiber size. An approximately 10 percent of myofibers had tiny vacuoles which contained periodic acid Schiff positive granules and were slightly high in acid phosphatase activity. The vacuoles were encircled by membranes with high neuron specific enolase (NSE) and acethylcholin-esterase (AchE) activities. On electron microscopy, numerous autophagic vacuoles scavenging glycogen granules were recognized as seen in acid maltase deficiency. Because the vacuolar membranes were high in NSE and AchE activities, lysosomal membrane formation from the cell membrane may be defective. When one has a patient with mild to moderate mental retardation, idiopathic hypertrophic cardiomyopathy and high serum CK level, muscle biopsy must be performed to rule out the present disorder.

[MELAS (mitochondrial myopathy, encephalopathy lactic acidosis, and stroke-like episodes): clinical features and mitochondrial DNA mutations]

MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) is one of the clinically-defined mitochondrial diseases, characterized by early onset and stroke-like symptoms. A point mutation at nucleotide pair 3243 within the tRNA-Leu (UUR) gene is found in 80% of MELAS patients and another mutation at nucleotide pair 3271 in 10%. In vitro and in vivo expression studies on 3243 mutant genome show that it affects both the transfer RNA and transcription termination functionally. By virtue of further analyses on relationship between the mutations and phenotypes, a new approach to deal with the disease could be obtainable.

Location of a glucose-dependent response region in the rat S14 promoter

The rat S14 gene provides an excellent model to examine the DNA sequences associated with carbohydrate regulation of hepatic gene transcription. We constructed internal deletions within 5 kilobases of the 5'-up-stream region and ligated these to a luciferase reporter gene. The constructs were transfected into primary hepatocytes and pancreatic HIT cells. In hepatocytes, an increase in the medium glucose concentration led to a parallel increase in endogenous mRNA S14 content and transfected luciferase reporter activity driven by 5 kilobases of the S14 promoter. Internal deletions of several sequences from -2706 to -285 each led to a decrease in glucose-stimulated activity, suggesting that multiple elements are necessary for the transcriptional response to glucose. Deletion from -1583 to -1069 nearly abolished the glucose effect in both cell types and delineated the carbohydrate response element (CHORE). The CHORE deletion was specific for glucose, because it did not alter the response to thyroid hormone, another known regulator of this gene. Although the CHORE sequence did not confer glucose activation to either a heterologous promoter or the basal S14 promoter (bases -285 to +19), a 5-fold enhanced response was observed when two copies of the CHORE were ligated to the first 2110 basepairs of the S14 promoter. The results suggest that the CHORE contains a carbohydrate regulatory element and operates as an enhancer in concert with other sequences within the S14 gene.

Nematocidal activity of turmeric: synergistic action of curcuminoids

A new curcuminoid, cyclocurcumin (IV), was isolated from the nematocidally active fraction of turmeric, the rhizome of Curcuma longa, together with three known curcuminoids, curcumin (I), demethoxycurcumin (II) and bisdemethoxycurcumin (III). The structure of IV was elucidated on the basis of spectral data and confirmed by the partial synthesis from curcumin (I). Although the above curcuminoids were ineffective when they were applied independently, the nematocidal activity increased remarkably when they were mixed, suggesting a synergistic action between them.

Sequential observation of mitochondrial distribution in mouse oocytes and embryos

OBJECTIVE

The purpose of this study was to elucidate changes in the distribution of mitochondria through the cell cycle.

MATERIALS AND METHODS

Mouse oocytes and embryos were recovered sequentially from mice and stained with the vital fluorescent mitochondrial stain rhodamine 123. Mitochondrial staining pattern were classified into three types: aggregation (Ag), homogeneous (H), and perinuclear accumulation (PA).

RESULTS

Sequential observations revealed that mitochondria of oocytes and embryos grown in vivo translocated in the cytoplasm during the cell cycle, showing the H pattern before human chorionic gonadotropin (hCG) administration, the PA pattern 8-9 hr post-hCG, the H pattern again 10-14 hr post-hCG, and the PA pattern again 24 and 31-32 hr post-hCG following fertilization. In the two-cell stage, the Ag pattern was shown 35 hr post-hCG, the H pattern was observed 40 hr post-hCG, and the PA pattern was found 48 hr post-hCG. In the embryos cultured in vitro and showing developmental block, mitochondrial translocation was shown to be inhibited after they aggregated in the early two-cell stage (35 hr post-hCG). Moreover, the translocation of mitochondria was restored by the addition of superoxide dismutase or thioredoxin to the culture medium. Both of these enzymes have already been shown to have the ability to overcome developmental block.

CONCLUSION

The present study revealed that mitochondria translocated in the cell cycle and suggested that there is a close relationship between mitochondrial translocation and developmental arrest.

Comparison of extracellular enzymes of Fusobacterium necrophorum subsp. necrophorum and Fusobacterium necrophorum subsp. funduliforme

A total of 10 strains each of Fusobacterium necrophorum subsp. necrophorum and Fusobacterium necrophorum subsp. funduliforme were tested for the production of 13 extracellular enzymes. DNase, alkaline phosphatase, and lipase were predominantly associated with all the strains of F. necrophorum subsp. necrophorum, with DNase not detected in any of the strains of F. necrophorum subsp. funduliforme. In addition, the strains of F. necrophorum subsp. necrophorum were generally more hemolytic than those of F. necrophorum subsp. funduliforme. Lecithinase, beta-lactamase, elastase, hyaluronidase, chondroitin sulfatase, and coagulase were not detected in any of the strains. DNase may be used to differentiate between the two subspecies.

[Disseminated Trichosporon beigelii infection: report of nine cases and review]

Trichosporon beigelii (formerly called Trichosporon cutaneum) is an emerging pathogen of disseminated trichosporonosis in immunocompromised patients. We conducted postmortem microbiological examinations of lung aspirates and blood in the heart. T. beigelii was isolated from the samples of 7 (2.24%) of 313 patients. Five of 7 patients isolated were diagnosed as having trichosporonosis based on histochemical and clinical findings. The other two were considered as colonization. Immunohistochemical study using Cryptococcus neoformans-absorbed antiserum to T. beigelii was carried out on the sections of autopsied tissues with deep mycoses. The sections from seven patients were positively stained, which were formerly diagnosed as candidiasis and/or aspergillosis. Consequently, 9 patients had disseminated trichosporonosis caused by T. beigelii. In Japan, 43 patients including the present 9, 31 males and 12 females, aged 51 (range, 2-84), were reported in the literature. Thirty-seven (86%) patients had hematologic malignancy, and the majority of them revealed profound neutropenia due to cytotoxic chemotherapy. Thirty-eight (88%) patients died despite the anti-fungal chemotherapy including amphotericin B. New strategies for refractory disseminated trichosporonosis in immunocompromised patients is needed.

Ryanodine wastes oxygen consumption for Ca2+ handling in the dog heart. A new pathological heart model

Ryanodine (RYA) at a low concentration (several tens of nM) is known to selectively bind to Ca2+ release channels in sarcoplasmic reticulum (SR) and to fix them open. The present study was designed to investigate the effects of the selective change in Ca2+ release channel activity on cardiac mechanoenergetics as a model of Ca(2+)-leaky SR observed in pathological hearts. We analyzed the negative inotropic effect of RYA at a low concentration (up to 30 +/- 13 nM) on left ventricular (LV) mechanoenergetics using frameworks of LV Emax (a contractility index) and the myocardial oxygen consumption (LV VO2)-systolic pressure-volume area (PVA) (a measure of total mechanical energy) relation in 11 isolated, blood-perfused dog hearts. RYA significantly decreased Emax by 42%, whereas PVA-independent VO2 remained disproportionately high (93% of control). This oxygen-wasting effect of RYA was quite different from ordinary inotropic drugs, which alter Emax and PVA-independent VO2 proportionally. The present result suggests that RYA suppresses force generation of cardiac muscle for a given amount of total sequestered Ca2+ by SR in a similar way to myocardial ischemia and stunning. We speculate about the underlying mechanism that RYA makes SR leaky for Ca2+ and thereby wastes energy for Ca2+ handling by SR.

[An analysis of the status of surgical transfusion and a trial of maximum surgical blood order schedule (MSBOS) in Fukui Medical School Hospital]

To evaluate the present status of surgical transfusion during operations, we computed the amount of preoperative preparation and intraoperative use of blood. And we examined cross-match to transfusion ratio (C/T ratio) and maximum surgical blood order schedule (MSBOS) based on the statistical data in our hospital. The result revealed that too much blood was prepared in our hospital. The amount of prepared blood was 12,825 units of which 2,419 units were transfused (1 unit = 200 ml of whole blood). The mean C/T ratio was 5.30. And a trial of MSBOS revealed that we could save 70% of the blood presently prepared. We are sure that the introduction of T & S and MSBOS will lead to more efficient transfusion in our hospital.

An immunohistochemical study of neurofilament and microtubule-associated Tau protein in the enteric innervation in Hirschsprung's disease

The distribution and localization of neurofilament (NF) and microtubule-associated tau protein (Tau) in the colon from Hirschsprung's disease were examined by immunohistochemistry. Specimens of the normoganglionic, oligoganglionic, and aganglionic segments of colons from nine patients with Hirschsprung's disease were used in this study. Normal colon specimens obtained at the time of colostomy closure from two patients with anorectal malformations were also examined as controls. In normoganglionic segments, anti-NF-H and anti-NF-M immunoreactivity appeared within the nerve fibers of both the myenteric and submucosal plexuses. These findings were also observed in the oligoganglionic segments. In the aganglionic segment, hypertrophic nerve fascicules and the nerve fibers in circular muscle were positively stained with anti-NF-H and anti-NF-M antibodies. Anti-Tau staining appeared in the ganglion cell bodies of both myenteric and submucosal plexuses and in nerve fibers distributed among the circular muscles of the normal control colons, and the normoganglionic and oligoganglionic Hirschsprung's specimens. Nerve fibers in the circular muscle layer of aganglionic segments were also stained with anti-Tau serum, although the hypertrophic nerve fascicules in the intermuscular and submucosal layers did not stain. The so-called nerve fascicules distributed in the subserosal layer also did not stain with anti-Tau. These results suggest that Tau may be used as a specific marker to identify ganglion cells and intrinsic nerve fibers in colons affected by Hirschsprung's disease.

[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.