Intravenous diadenosine tetraphosphate in dogs. Cardiovascular effects and influence on blood gases

Diadenosine tetraphosphate (AP4A) has a considerable vasodilating effect. Its dose was adjusted to decrease mean arterial pressure (MAP) by 20%, 40%, 50%, 60%, and 80% of the pretreatment value, and the effects on hemodynamics and gas exchange were evaluated. AP4A produced a dose-dependent decrease in MAP within the range of doses which decreased blood pressure by up to 60%. Heart rate remained constant at hypotension levels of 40% or less, but decreased significantly at hypotension levels of 50% or more. Cardiac output increased significantly at hypotension levels of 40% or less. Systemic vascular resistance (SVR) showed a significant decrease at that time. No significant changes were observed in central venous pressure and pulmonary capillary wedge pressure at any level of hypotension. Arterial oxygen tension and calculated pulmonary shunt ratio showed no change. Base excess and pH were decreased significantly with a 60% or 80% fall of blood pressure. In conclusion, AP4A seems to act on the resistance vessels and cause a decrease in SVR.

The efficacy of non-clamping selective cerebral perfusion in distal aortic arch aneurysm repair: report of a case

Successful repair of a distal aortic arch aneurysm without aortic cross-clamping was carried out in a 74-year-old man, using a combination of special separate cerebral perfusion and retrograde coronary perfusion, termed non-clamping selective cerebral perfusion. We believe that satisfactory results following aortic arch surgery in elderly patients can only be achieved through the prevention of emboli derived from an aortic cross-clamping site, and shortened ischemic time of the vital organs.

Characterisation of the external surfaces of Pseudomonas aeruginosa isolated from human blood and respiratory tract

The surface structures of the cell envelopes of 16 clinical isolates of Pseudomonas aeruginosa were examined by electronmicroscopy with the new fixation technique of freeze-substitution. Two types of structures were observed among the organisms. In one group of strains, mostly isolated from blood, a dense fibrous layer c. 30 nm thick was found around the outer-membrane surface, whereas no such structure was observed in the other group of isolates, most of which were from sputum. Lipopolysaccharides extracted from the isolates with a dense fibrous layer were found by SDS-PAGE to have long O-polysaccharide chains, whereas strains without such a layer mostly had lipopolysaccharides that lacked high mol. wt. O-polysaccharide chains.

Multiple ileal carcinoids and appendiceal endocrine carcinoma in association with Meckel's diverticulum. A histochemical and immunohistochemical study

An unusual case of multicentric ileal carcinoids and appendiceal endocrine carcinoma in association with Meckel's diverticulum was studied, with special attention given to the histogenesis of these neoplasms. A total of six ileal carcinoids, the largest of which was located in the wall of Meckel's diverticulum, were macroscopically and microscopically confirmed to be multicentric and revealed no visceral metastases. The histochemical and immunohistochemical profiles of the ileal carcinoids and the appendiceal carcinoma differed considerably: the former resembled subepithelial neuroendocrine cells and the latter resembled epithelial nonmucous cells and Paneth cells. The appendiceal carcinoma exhibited signs of endocrine differentiation, expressing somatostatin and vasoactive intestinal polypeptide, and secreted mucus. The tumor had metastasized to various organs. The carcinoids exhibited signs of neuroendocrine and glandular differentiation, expressing neuron-specific enolase, serotonin, chromogranin A, and endocrine granule constituent, and secreted little mucus. The data suggest different tumor cell origins or different grades of differentiation of the two types of intestinal endocrine cell tumor.

Parosteal osteosarcoma. A clinicopathological study

The records of 226 patients (sixty-seven who were managed at our institution and 159 who were identified from the consultation files) who had had a parosteal osteosarcoma were reviewed. The criteria for diagnosis were that, roentgenographically, the lesion had arisen from the surface of the bone and that, histologically, the tumor was well differentiated (Grade 1 or 2); it was characterized by well formed osteoid within a spindle-cell stroma; and, when there was medullary involvement, less than 25 per cent of the medullary cavity was affected. Dedifferentiation was more common (16 per cent of the patients) than previously reported and was associated with a poor prognosis. Cross-sectional imaging studies demonstrated medullary involvement in 22 per cent of the patients, an unmineralized soft-tissue mass peripheral to the mineral component in 51 per cent, and adjacent soft-tissue invasion in 46 per cent. In contrast to the findings in our previous studies, medullary involvement was not a poor prognostic factor. At an average of thirteen years (range, two to forty-one years), eleven of the sixty-seven patients who were managed at our institution died of the tumor; ten of these patients had a dedifferentiated tumor. Statistical analysis of the thirty-nine patients who had had the primary treatment at our institution revealed that incomplete resection was associated with an increased risk of local recurrence and that dedifferentiation markedly increased the risk of metastasis.

[Malignant mesenchymoma of the spermatic cord: a case report]

A 50-year-old man visited our clinic with the complaint of a painless, growing swelling in the left inguinal region. High inguinal orchiectomy including tumor resection was performed. The tumor originated in the spermatic cord without invading the epididymis or the testis. Histologically, the tumor consisted of osteosarcoma, leiomyosarcoma, and liposarcoma, which was compatible with the pathological finding of malignant mesenchymoma. Postoperatively, the patient received 2 courses of adjuvant chemotherapy according to the CYVADIC regimen. He is alive 12 months after surgery with no evidence of tumor recurrence or metastasis. Malignant tumors of the spermatic cord are rare, especially malignant mesenchymoma. Our case is the 7th one so far reported in Japan.

Opposite changes in serum sodium and potassium in patients in diabetic coma

We studied the changes in serum sodium (Na) and potassium (K) levels in seventeen patients in diabetic ketoacidosis and nine patients in non-ketotic hyperosmolar coma, who had marked hyperglycemia (707.4 +/- 75.6 mg/dl, mean +/- SEM) and dehydration. The disorder characterized two types of alteration. The one group was hyponatremia with hyperkalemia in 17 patients in diabetic ketoacidosis (132.9 +/- 2.0 and 5.7 +/- 0.2 mEq/l), and 4 patients in non-ketotic hyperosmolar coma (125.8 +/- 4.3 and 5.2 +/- 0.5 mEq/l). The other was hypernatremia (162.5 +/- 1.8 mEq/l) with hypokalemia (3.4 +/- 0.2 mEq/l) in 5 patients in non-ketotic hyperosmolar coma. Intensive therapy with insulin and fluid administration improved the diabetic hyperglycemia and associated abnormalities. The vectors showing the normalization of serum Na and K levels was in quite opposite directions between the patients with hyponatremia with hyperkalemia and those with hypernatremia with hypokalemia. The amounts of loss of circulatory blood volume exceeded 20% in three groups of patients, a loss greater in the hypernatremic patients than in the hyponatremic ones. These results indicate that serious body water depletion produces hypernatremia instead of hyponatremia in patients in diabetic coma. The disorder may be caused by the altered distribution of electrolytes between the intra- and extra-cellular spaces.

[Statistic studies on bacteria isolated from urinary tract infections (report 6: isolation rate and drug sensitivity from 1988 through 1989)]

We examined the bacteria isolated from urine of patients in our department from 1988 though 1989. A total of 809 strains were isolated from the outpatients. They were 241 strains of gram-positive bacteria (29.8%). E. coli (32.0%) was isolated most frequently, followed by Enterococcus spp. (9.9%), Proteus group (7.4%), S. epidermidis (6.2%), P. aeruginosa (5.1%) and others. A total of 412 strains were isolated from the inpatients. They consisted of 173 strains of gram-positive bacteria (42.0%). Enterococcus spp. (17.0%) was isolated most frequently, followed by P. aeruginosa (12.6%), S. epidermidis (9.7%), E. coli (7.3%), S. aureus (6.6%) and others. Fewer P. aeruginosa, S. marcescens and Proteus group were isolated from the outpatients and fewer S. marcescens, E. coli and K. pneumoniae from inpatients than previously. More S. aureus were isolated abruptly from the inpatients and more E. coli were isolated from the outpatients than previously. E. cloacae, S. epidermidis, S. aureus and Corynebacterium spp. all isolated from inpatients showed lower antimicrobial sensitivity than those isolated from the outpatients.

Cerebrospinal fluid concentrations of interleukin-1 beta, tumour necrosis factor-alpha, and interferon gamma in bacterial meningitis

To investigate the role of the inflammatory cytokines, the cerebrospinal fluid concentrations of interleukin (IL)-1 beta, tumour necrosis factor-alpha (TNF-alpha), and interferon gamma (IFN-gamma) were measured in 11 children with bacterial meningitis and two with mycoplasmic meningoencephalitis and compared with those in 50 children with aseptic meningitis and 15 with non-pleocytotic cerebrospinal fluid. Concentrations of IL-1 beta and TNF-alpha were each significantly higher in the cerebrospinal fluid of patients with bacterial meningitis than in those with aseptic meningitis or those with non-pleocytotic cerebrospinal fluid. IFN-gamma was detected at low concentrations in the cerebrospinal fluid of only 2/11 of those with bacterial meningitis. On the other hand, the IFN-gamma concentration was the highest in the cerebrospinal fluid of patients with aseptic meningitis. These results suggest that the inflammatory cytokines are differently released in the intrathecal space infected with viruses or bacteria.

[Systematic cleaning of the mite antigens in home environment and its effects on atopic dermatitis]

Since mite antigen is an important causative agent of atopic dermatitis (AD), establishment and maintenance of a mite-reduced home environment would be an effective means to mitigate the symptoms. For establishing and maintaining a mite-reduced home environment, the structure of the residence, as well as the life style of the residents are important factors to consider. Based on a hypothesized behavior of the mite antigens a cleaning program was developed. Application of this program for establishing and maintaining a mite-reduced room in a patient's home produced a reduction in both mite population and mite antigen level, as well as a mitigation of the patient's symptoms. An air purifier was shown to have the ability to reduce, to a certain extant, specific mite antigens. The results suggest that an air purifier would be an effective contribution to the maintenance of a mite-reduced home environment.

Immunopathologic study and characterization of the phenotype of transformed cells in sheep with bovine leukemia virus-induced lymphosarcoma

We used monoclonal antibodies and immunohistologic examination of lymph nodes, to elucidate the pathogenesis of lymphosarcoma induced by infection with bovine leukemia virus (BLV). The superficial cervical lymph nodes from 3 BLV-infected but apparently healthy sheep and 5 sheep with full-blown lymphosarcoma were examined. We also investigated the integration of bovine leukemia provirus by use of Southern blotting. In lymph nodes from sheep lacking clinical signs of infection, in which the provirus had been integrated at multiple sites in the genome, many large hypertrophic follicles were observed in the cortex. These follicles had germinal centers consisting of CD4+T cells and B cells that expressed surface IgM (sIgM) and major histocompatibility complex (MHC) class-II antigens, but not B cell-specific B2 molecule. The percentage of CD4+T cells in the cortex was significantly (P < 0.05) higher than that of the controls and sheep with lymphosarcoma. In all sheep with lymphosarcoma, the lymph nodes were completely destroyed by proliferating neoplastic cells, and in addition, small atrophic follicles, which consisted of normal B-cell marker-positive cells, were seen near the trabecula and the subcapsule. In these instances, neoplastic cells appeared to be a monoclonal population derived from a single CD5- B-cell lineage and to be classified as 2 types, CD5-CD4-CD8-B2+MHC class-II+sIgM+ and CD5-CD4-CD8-B2+MHC class-II+sIgM-. Moreover, CD8+T cells infiltrated diffusely throughout the tumorous lymph nodes apart from the atrophic follicles, and CD4+ cells were observed around atrophic follicles. Both types of T cells were small-size, normal lymphocytes with round and noncleaved nuclei, and were apparently non-neoplastic cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatocellular carcinoma in 13 patients with hepatitis C virus-associated chronic hepatitis

Thirteen of 81 patients with chronic hepatitis and positive hepatitis C virus (HCV) antibody developed hepatocellular carcinoma (HCC) during a follow-up period of 54 +/- 38 months. The histopathological findings in HCC-bearing liver in these patients included six cases of chronic persistent hepatitis [CPH; mean hepatitis activity index (HAI) score: 5.8] and seven cases of chronic aggressive hepatitis (CAH) 2A, or 2B (HAI) score: 13.6). Multiple biopsies of the liver in six cases revealed that five cases, including four with CPH at the time of HCC diagnosis, previously had histopathological findings identical to CAH 2A, and another case constantly had CPH during the 8-year follow-up. These findings suggest that HCV-associated HCC can occur even in patients with HCV antibody positivity and inactive or mild chronic hepatitis. This is of interest in the pathogenetic mechanisms of HCV-associated HCC.

Atrial natriuretic peptide and cGMP inhibit Na+/H+ antiporter in vascular smooth muscle cells in culture

The aim of the present paper was to study the mechanisms of the inhibitory effect of atrial natriuretic peptide (ANP) on the sustained contraction phase of vascular smooth muscle cells (VSMC). Specifically, the potential role of ANP on the Na+/H+ antiporter and Na+ transport systems was investigated. Both ANP and 8-bromo cGMP inhibited 22Na+ uptake and decreased intracellular Na ([Na+]i) in VSMC, an effect that was mimicked by the specific Na+/H+ antiporter inhibitor, hexamethylen amiloride (HMA). The effect of ANP was not additive with HMA, therefore suggesting that both inhibit the same 22Na+ transport pathway. On the other hand, the inhibition of 22Na+ accumulation by ANP was additive with the inhibition by furosemide or bumetanide, thus suggesting that both drugs act on different Na+ exchange systems. In HEPES-buffered medium, ANP, cGMP, and HMA significantly inhibited the AVP-induced intracellular alkalinization, an effect which was associated with significant inhibition of the AVP-induced shape change. In bicarbonate buffered medium, ANP and cGMP decreased the pH level below the baseline after application of AVP, and an inhibition by ANP and cGMP of AVP-induced VSMC shape change was also observed. The recovery of cellular pH after three different types of acid load, namely, ammonium chloride pulse, nigericin clamp and lowering of extracellular pH, was significantly decreased by ANP and cGMP. Taken together, these results indicate that ANP/cGMP inhibit the activity of the Na+/H+ antiporter in VSMC, either in hormone- or pH-stimulated conditions.

Effect of bone resorbing factors on u-PA and its specific receptor in osteosarcoma cell line

This study investigated the effect of bone resorbing factors on the pericellular fibrinolytic system of osteosarcoma NY cells. Parathyroid hormone (PTH), prostaglandin E2, (PGE2) or tumor necrosis factor alpha (TNF-alpha) enhanced the secretion of urokinase-type plasminogen activator (u-PA) antigen and suppressed the secretion of plasminogen activator inhibitor-1 (PAI-1) antigen to the conditioned medium. The former two factors also increased u-PA antigen in the cell surface. Transforming growth factor beta (TGF-beta) enhanced u-PA antigen, but its activity was suppressed due to the increased secretion of PAI-1. The binding assay of [125I]DFP-u-PA to NY cells revealed the presence of a single class of binding sites with a Kd of 5.51 nM and Bmax of 0.92 x 10(5) binding sites/cell. PTH or PGE2 increased Bmax 1.4-fold and enhanced the u-PA receptor (u-PAR) mRNA level 1.4-fold or 2.4-fold, respectively. However, TGF-beta did not alter either the Kd or u-PAR mRNA level. Thus, pericellular fibrinolytic activity by u-PA/u-PAR and PAI-1 is modulated by bone resorbing factors.

Assessment of flow profile of left anterior descending coronary artery in hypertrophic cardiomyopathy by transesophageal pulsed Doppler echocardiography

This study assessed the flow velocity profiles of the left anterior descending coronary artery (LAD) in 7 patients with nonobstructive hypertrophic cardiomyopathy (HC) and in 6 normal subjects by transesophageal pulsed Doppler echocardiography, and evaluated their characteristics and the hemodynamic determinants. Systolic peak flow velocity of the LAD (7 +/- 30 cm/sec) was significantly lower in patients with HC than in normal subjects (34 +/- 11 cm/s, p < 0.05), and there was a significant inverse correlation between systolic peak flow velocity and the thickness of the ventricular septum (r = 0.81, p < 0.01). In 2 cases of HC with ventricular septal thickness of > 20 mm, a remarkable systolic reverse flow was observed in the LAD. However, there was no significant difference in diastolic peak flow velocity between HC and normal subjects. During early diastole, the acceleration time of LAD flow velocity was significantly prolonged (210 +/- 67 vs 95 +/- 15 ms, p < 0.01) and the acceleration rate was significantly decreased (3.6 +/- 2.0 vs 6.6 +/- 1.8 m/s2, p < 0.02) in patients with HC. The time constant of the left ventricular pressure decay was significantly prolonged in patients with HC (55 +/- 6 ms) compared with normal subjects (39 +/- 2 ms, p < 0.001). In HC, increased intramural perivascular pressure of the thickened ventricular septum during systole may be attributed to systolic LAD flow pattern. However, the early and mid-diastolic LAD flow pattern may be affected by impaired left ventricular relaxation.

[A case report of aneurysm of the diverticulum of the ductus arteriosus]

A 59-year-old man who was admitted with hoarseness and diagnosed as aneurysm of the diverticulum of the ductus arteriosus was reported. In our case, enhanced computed tomography and aortography gave reliable informations. Operation was performed through a posterolateral thoracotomy under partial cardiopulmonary bypass. The aneurysm was successfully resected and defect of the aortic wall was covered with Dacron patch. Postoperative course was uneventful. To our knowledge, this is 12th surgically treated case in Japan.

[Traumatic tricuspid regurgitation--report of two cases and review of operated cases]

Two cases of nonpenetrating traumatic tricuspid regurgitation were reported. The first case, a 46-year-old man who had an episode of traffic accident 21 years ago, was admitted with complaints of peripheral edema and dyspnea on exertion. The second case was a 16-year-old man who noted to have cardiac murmur and cardiomegaly after 4 years of a traffic accident. In both cases, cardiac catheterization showed increased right atrial pressure with high v wave, and echocardiogram showed severe tricuspid regurgitation with ruptured chordae tendineae of the anterior leaflet. Tricuspid valve replacement was performed successfully in both the cases. Twenty-two operated cases of traumatic tricuspid regurgitation have been reported in Japan; 17 of ruptured chordae tendineae, 3 of ruptured papillary muscle, and 2 of primary laceration of anterior leaflet. The patients with ruptured papillary muscle were operated from 2 months to 7 years (average 4 years) after trauma, while those with ruptured chordae tendineae were operated from 5 months to 25 years (average 10 years) after trauma. Tricuspid valve replacement was performed in 17 of 22 cases. From the review of 22 cases, tricuspid valve replacement should be indicated for traumatic tricuspid regurgitation in consideration of the severity of valve destruction regardless of the interval after trauma.

Expression of growth hormone receptor gene in rat hypothalamus

Growth hormone receptor (GHR) mRNA-expressing cells in the hypothalamus were observed using hybridization histochemistry in adult male rats. Digoxigenin-labeled cRNA corresponding to the extracellular part of rat GHR was used as a probe. Northern blotting analysis of hypothalamic total RNA from adult male rats revealed that the 4.5 kilobase (kb) transcript of the GHR gene corresponding to the GHR messenger RNA (mRNA) predominated over the 1.2 kb transcript corresponding to GH-binding protein mRNA. GHR mRNA-containing cells were observed in the arcuate nucleus (ARC), the periventricular nucleus (PeV), ventrolateral region of the ventromedial nucleus, the paraventricular nucleus and the supraoptic nucleus. To further understand the significance of the GHR gene expression in the hypothalamus, the effect of in vivo manipulation of GH on the somatostatin (SS) gene expression in the ARC and PeV, and the GRF gene expression in the ARC was observed among adult male rats using in situ hybridization histochemistry. Ten days after hypophysectomy, the SS mRNA level in the ARC as well as PeV was significantly lower than that in the respective nuclei of sham-operated control rats, while the GRF mRNA level in the ARC was significantly higher than that in the ARC of control animals. Subcutaneous injection of recombinant human GH (0.33 mg) to hypophysectomized rats every 12 h for 5 days restored the SS mRNA level in the ARC and PeV, and reduced the GRF mRNA level in the ARC to that of control animals. The data suggest that GH directly acts on the hypothalamic PeV and ARC, and alters the gene expression of SS and GRF.

[Biochemical modulation of chemotherapy of urologic malignancies]

Generally speaking, the outcome of cancer chemotherapy for urologic malignancies is poor. This poor response is attributed to the weak sensitivity to anti-cancer agents, represented by renal cell cancer, and the advanced age of most patients to tolerate the toxicities of the drugs, as is experienced in prostate cancer patients, which leads to insufficient therapy. Biochemical modulation was initially used to refer to the enhancement of the effect of 5-FU by modulating its pharmacological action by the addition of other drugs. The concept was expanded to the enhancement of the effect of the chemotherapeutic agents, potentiating the pharmacological action and/or reducing the toxicity, by means of any drug or biological modality. This preface is for the following 7 articles which were based on the presentations at the Symposium of 42nd Annual Meeting of Central Section of Japanese Urological Association in 1992, entitled as "Biochemical modulation of chemotherapy of urologic malignancies".