[The effects of osmolarity in reperfusion solution upon myocardial protection]

The effects of several different osmolarity in reperfusion solution were studied. Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas Cardioplegic Solution (STS) followed by global ischemia for 33 min at 37.5 degrees C, 15 min early Langendorff reperfusion with different osmolarity by adding sucrose and 5 min late reperfusion with Krebs Henseleit bicarbonate buffer, followed by 20 min working perfusion. Percent recoveries of aortic flow showed that 290 mOsm/L in reperfusion solution possessed optimal protective properties with bell shaped dose response characteristics.

Positron labeled antioxidants: synthesis and tissue biodistribution of 6-deoxy-6-[18F]fluoro-L-ascorbic acid

A one-pot synthesis of 6-deoxy-6-[18F]fluoro-L-ascorbic acid (18F-DFA) has been developed via nucleophilic displacement of a cyclic sulfate with no-carrier-added [18F]fluoride ion. Isolated radiochemical yields of around 15% were obtained with radiochemical purity of over 99% after overall synthesis time of 90 min. Tissue distribution studies with 18F-DFA in rats showed high uptake of radioactivity in the adrenals, kidneys, liver and small intestine--organs known to have high concentrations of L-ascorbic acid. The slow and low uptake of radioactivity in the brain was observed between 10 and 120 min after i.v. injection. In vivo behavior of 18F-DFA in mice bearing 3-methylcholanthrene-induced fibrosarcoma demonstrated its ability to accumulate in the tumor.

[Significance of the cerebral venous system in the development of DIND in subarachnoid hemorrhage]

The significance of superficial venous system in the development of delayed ischemic neurological deficit (DIND) was studied retrospectively in 18 patients with ruptured aneurysm of the middle cerebral artery (MCA). Neck clipping of the aneurysms was performed via the pterional approach within 72 hours after onset of subarachnoid hemorrhage. All patients were in grade I or II of the Hunt and Hess Grading, and in group 2 or 3 on Fisher's CT classification. The age ranged from 32 to 71 with 48.1% being the mean age. The aneurysm was located on the left side in 5 patients, and on the right side in 13 patients. Arterial and venous phase were evaluated on the pre-and post operative angiograms in these patients. Arterial narrowing was divided into localized and diffuse types according to the degree, and its distribution in the arterial tree. In the venogram, opacification of the superficial sylvian veins (SSV) was the main thing evaluated. Arterial narrowing was observed in 16 cases (9; localized, 7; diffuse). In some cases, visualization of the SSV was poor or fair, and in others it was normal. DIND, including motor deficit or disturbance of consciousness, developed in 10 cases (transient; 6, permanent; 4). The patients with normal visualization of SSV on the postoperative angiogram had good outcome, even if they had diffuse arterial narrowing. On the other hand, the outcome was only fair or poor in those patients who had poor visualization of the SSV, irrespective of arterial narrowing.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of light and darkness on pH outside rod photoreceptors in the cat retina

We recorded pH in the extracellular space surrounding rod photoreceptors in the dark-adapted eye of the cat and during illumination with double-barreled H(+)-selective microelectrodes. A pH of 7.17 was recorded in the vitreous at the retinal surface of the dark-adapted eye and this became more alkaline during light adaptation. In dark adaptation, a pH close to 7.00 was recorded in a region of maximal acidity in the extracellular space surrounding rods in the outer nuclear layer (ONL). pH steeply alkalinized as the microelectrode was moved more distally towards the retinal pigment epithelium (RPE), and almost reached the pH of the arterial blood at the apical surface of the RPE. Illumination produced an intraretinal alkalinization that was largest (up to 0.2 pH units) in the ONL, maximal in amplitude at rod-saturating intensities, and that was sustained during steady background illumination. The light-evoked alkalinization was relatively slow in onset, having a time constant (1/e) of 64 sec, and took 8-12.5 min to return to the dark-adapted level after the offset of maintained illumination. These results show that acid production by cat rods is highest in the dark, reflecting a high rate of energy metabolism, and suggest that glycolysis is required to support the dark current. Illumination, by suppressing both glycolysis and respiration, alkalinizes the extracellular space surrounding rods. The substantial change in pH outside rods from dark to light could alter pH dependent properties of the interphotoreceptor matrix.

Effects of systemic hypoxia on pH outside rod photoreceptors in the cat retina

We studied the effect of systemic hypoxia on intraretinal pH in the intact cat eye using double-barreled H(+)-sensitive microelectrodes. Hypoxia in the dark further acidified the extracellular space surrounding rods in the distal retina and this effect was maximal in the outer nuclear layer (ONL). An acidification occurred in response to essentially any decrease in PaO2 below the normoxic level. Light-evoked alkalinizations in the ONL were larger in amplitude during hypoxia than in normoxia and this difference increased with the severity of hypoxia. Background illumination suppressed the hypoxic acidification of the ONL, completely inhibiting it at rod saturating intensities, at levels of hypoxia down to PaO2s of 40 mmHg. Systemic hyperoxia produced a small alkalinization in the ONL, and a reduction in the amplitude of the light-evoked alkalinizations. This suggests that systemic hyperoxia can partially suppress the ongoing glycolysis of dark-adapted rods. Changes in blood flow during hypoxia also altered intraretinal pH. Hypoxia led to an alkalinization in the choroid in both dark and light adaptation that spread into the distal retina. This alkalinization is most likely caused by the increase in CO2 removal that occurs as systemic blood pressure, and as a consequence, choriocapillaris blood flow increase during hypoxia. The alkalinization attenuated the acidification that was observed outside rods during hypoxia. There was also an alkalinization of the proximal portion of the retina, which spread into the vitreous. This alkalinization was attributed to the autoregulatory increase in blood flow that occurs in the retinal vessels during hypoxia. These findings provide further evidence for the hypothesis that the energy metabolism of dark-adapted rods is exquisitely sensitive to systemic hypoxia so that any small decrease in PaO2 increases rod glycolysis. Rod-saturating illumination can completely suppress this increase in glycolysis for all but severe hypoxia. An increase in blood flow in the choriocapillaris during hypoxia appears to mitigate the effects of hypoxia on the distal retina.

Light-evoked changes in [K+]o in proximal portion of light-adapted cat retina

1. The M-wave is a light-adapted response of proximal retina consisting of phasic negative field potentials at light onset and offset that are spatially tuned for small stimuli. We measured light-dependent changes in extracellular K+ concentration ([K+]o) in proximal retina to investigate the hypothesis that the M-wave originates from Müller cell responses to changes in [K+]o. 2. Extracellular field potentials, and changes in [K+]o evoked in response to circular spots of light flashed on steady backgrounds, were recorded with double-barreled K(+)-sensitive electrodes placed in the retina at different depths. 3. Increases in [K+]o during illumination and at light offset were maximal in proximal retina, with the On [K+]o increase located more proximally than the Off increase. The [K+]o increase during illumination consisted of a phasic and sustained response, whereas the Off [K+]o increase was predominantly phasic. The spatial tuning of the [K+]o increases was similar to the tuning of the field potentials. 4. The Off-field potential was larger than the On potential; it tended to be maximal more distally and was more sharply localized in retinal depth. Stimulus-response characteristics of the field potentials were not altered by intravitreal tetrodotoxin (TTX; 3.8 microM) sufficient to block retinal ganglion cell action potentials. 5. There were no rod contributions to the proximal [K+]o increases and field potentials recorded at the background illuminations used in this study (9.5-11.5 log q.deg-2.s-1). 6. An intravitreal injection of L- or DL-2-amino-4-phosphonobutyric acid (APB; 1 mM) was used to block On-system neuronal responses in proximal retina and isolate Off-system responses. After APB the [K+]o response consisted of a sustained decrease in [K+]o during illumination followed by an overshoot at light offset, while the field potential was a sustained positive response at light onset followed by an initially phasic negative response at light onset followed by an initially phasic negative response at light offset. These responses retained spatial tuning. To isolate the On-system components, the APB-isolated responses were subtracted from the controls. The [K+]o response now consisted of a sustained increase during illumination followed by an undershoot at light offset. The field potential was a sustained negative potential with an initial phasic peak that decayed at Off. Results with kynurenate (KYN; 5 mM) and (+/-)cis-2,3-piperidine (PDA; 5 mM) confirmed the sustained nature of the On component.(ABSTRACT TRUNCATED AT 400 WORDS)

Effects of intravenous acetazolamide on retinal pH in the cat

Double-barreled H(+)-selective microelectrodes were used to study the effect on intravenous acetazolamide on intraretinal pH in the cat. Acetazolamide (11.4-27.8 mg kg-1 intravenously) caused a rapid acidification of the subretinal space. This change in pH originated in the most distal portion of the subretinal space and could not be attributed to a change in pH or PCO2 of the arterial blood. Slow light-evoked alkalinizations in distal retina, attributable to a decrease in rod photoreceptor energy metabolism, were relatively unaltered by acetazolamide. This result indicated that acetazolamide had not crossed the blood-retinal barrier in sufficient amounts to change this response. In time, following intravenous perfusion of acetazolamide, continuous depth profiles of intraretinal pH showed an acidification of the entire retina and the vitreous also became more acidic. These results indicate that the rapid or primary effect of acetazolamide is an acidification of the distal portion of the subretinal space, which is thought to originate in a change in the transport of H+ or HCO3- by the retinal pigment epithelium. This is followed by an acidification of the entire retina and vitreous, presumably due to diffusion of acid from the distal retina, although there could be additional causes.

[The effects of sodium concentration in reperfusion solution upon myocardial protection]

The effects of several sodium concentrations in reperfusion solution (RS) were studied. Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas Cardioplegic Solution followed by global ischemia for 33 min at 37.5 degrees C, 15 min early Langendorff reperfusion with various sodium concentrations modified with Krebs Henseleit Bicarbonate Buffer (KHBB) and 5 min late reperfusion with KHBB, followed by 20 min working perfusion. Percent recoveries of aortic flow and Creatine Kinase leakage showed that 110 mM sodium of RS possessed optimal protective properties with bell shaped dose response characteristics.

[Effects of endothelin on retinal blood vessels]

Endothelins (ETs), which are one of the most potent vasoconstrictors, were discovered in 1988. ETs are involved in the regulation of vascular smooth muscle and are thought to function like a local hormone. In this study, we measured changes in the caliber of retinal blood vessels caused by the intravitreal injection of ET 1 in rabbits, using fundus photography. The retinal artery showed an immediate vasoconstriction after the injection (0.1 ml) of ET 1 at 10(-6)M. However, ET 1 in lower concentrations (10(-7)M and 10(-8)M) caused vasodilations initially and subsequently vasoconstrictions. A dose-response relation was found. The blood vessel caliber reduced maximumly to 53% the value before injection. The vasoconstriction due to ET 1 may induce retinal ischemia and hypoxia. We speculate that ET 1 may be involved in the regulation of retinal blood vessels.

Ubiquitous presence in mammalian cells of enzymatic activity specifically cleaving 8-hydroxyguanine-containing DNA

Here we report the finding of enzymatic activity that specifically cleaves DNA containing 8-hydroxyguanine (oh8Gua) residues in various mammalian cells. To detect this activity, we used a synthetic double-stranded DNA containing a single oh8Gua at a defined position as the substrate, and analyzed the products of enzymatic digestion by polyacrylamide gel electrophoresis. Two cleavage sites near the oh8Gua residue were detected with partially purified fractions from cow brain and rat liver, and also with preparations from all mammalian tissues examined. These results suggest that enzymatic activity for the removal of oh8Gua from DNA is widely distributed in mammalian cells.

[A case of microsurgically removed cavernous angioma in the midbrain]

The authors presented a case of microsurgically removed large cavernous angioma in the midbrain. A 46-year old woman was admitted to our service with bilateral nuclear oculomotor pareses and mild tetraparesis. MRI revealed a large round well-circumscribed high signal-intensity lesion on both T1 and T2 weighted image with low signal rim in the midbrain. This lesion was diagnosed preoperatively as a cavernous angioma. The operation was performed in three steps with intermittent hemorrhages by interhemispheric transcallosal-hippocampal commissure--velum interpositum-third ventricular approach and subsequent two infratentorial supracerebellar approaches and finally complete removal was performed. Histological examination of the surgical specimen revealed as a cavernous angioma having abnormal vessels with honeycomb appearance. The patient survived, although remains moderately disabled 6 months after the last operation.

Continuous monitoring of blood oxygen saturation of internal jugular vein as a useful indicator for selective cerebral perfusion during aortic arch replacement

We continuously monitored blood oxygen saturation in the internal jugular vein during selective cerebral perfusion for aortic arch operations and evaluated its efficacy as an indicator of cerebral oxygen metabolism. The selective cerebral perfusion method was applied in 11 patients who underwent operations for aortic arch replacement. Blood oxygen saturation in the internal jugular vein was continuously monitored at the bulbus jugularis with a fiberoptic catheter during the operation. Perfusion flow of 500 ml/min was continued for 134.7 +/- 14.9 minutes under moderate hypothermia at 25 degrees C, and bilateral temporal arterial pressure was 40 to 60 mm Hg. Blood gas data were used to estimate oxygen consumption, oxygen extraction ratio, and lactate uptake in the cerebrum. No patients had postoperative cerebral complications. Cerebral oxygen consumption was 2.93 +/- 0.4 ml/min/100 gm under general anesthesia at 36 degrees C. While selective cerebral perfusion at 25 degrees C decreased consumption to 0.92 +/- 0.39 ml/min/100 gm, it fell to about 30% of its former value. Blood oxygen tension in the internal jugular vein showed no significant correlation with rectal temperature. Selective cerebral perfusion did not significantly affect cerebral lactate uptake. In contrast, blood oxygen saturation in the internal jugular vein was significantly affected by temperature and cerebral flow during selective cerebral perfusion, and blood oxygen saturation in the internal jugular vein correlated closely with cerebral oxygen extraction ratio (r = 0.91). Cerebral oxygen metabolism was thus well maintained, and continuous monitoring of blood oxygen saturation in the internal jugular vein was found to serve as a useful indicator under selective cerebral perfusion during operations for aortic arch replacement.

[The effects of magnesium concentration in reperfusion solution upon myocardial protection]

Experimental time course was as follows: 20 min working perfusion, 3 min cardioplegic infusion with St Thomas Cardioplegic Solution followed by global ischemia for 35 min at 37.5 degrees C, 15 min first Langendorff reperfusion with reperfusion solution (RS) with various concentrations of Mg and 5 min second reperfusion with KHBB, followed by 20 min working. Cardiac functions were measured during pre and post working perfusion and CK leakage were measured during reperfusion. Percent recoveries of aortic flow at the Mg concentration of 0, 0.6, 1.2, 3.0, 6.0, 12 mM were 21 +/- 5, 22 +/- 3, 48 +/- 2, 37 +/- 4, 28 +/- 3, 15 +/- 3 (%) (mean +/- SEM), respectively. Our data indicated that 1.2 mM Mg of RS possessed protective properties with bell shaped dose response characteristics.

[Ventricular septation combined with arterial switch for a patient with double inlet left ventricle with right sided rudimentary right ventricle and ventriculoarterial discordance]

A 5-year-old boy with double inlet left ventricle and ventriculoarterial discordance (SDD type) underwent ventricular septation with arterial switch procedure. Previously he had received pulmonary arterial banding at 3 months-old. Preoperative cardiac catheterization revealed Qp/Qs 1.26, Pp/Ps 0.19 and LVEDV was 315% of normal (as left ventricle). Arterial switch with Lecompte modification was performed in order to separate ventricle with straight patch could be done. Post operative course was uneventful and patient was extubated 4 post operative day. These procedures had employed in this patient as follows; 1) systemic ventricle could be constructed with morphological left ventricle with mitral valve. 2) left ventricular outflow tract stenosis due to ventricular outlet foramen occasionally observed in conventional procedure such as intraventricular rerouting could be prevented, and 3) ventricular septation could be easy and simple with straight patch.

[Modified Fontan operation for a single ventricle with a nonconfluent pulmonary artery]

A 8-year-old boy with a double inlet right ventricle with a non-confluent pulmonary artery was operated on with a modified Fontan operation. He had right isomerism, right aortic arch, bilateral superior caval veins, and left-sided inferior caval vein. Hepatic veins were separately drained to the right-side atrium. Left Blalock-Taussig shunt and right central shunt operations had been previously performed. Firstly, we had reconstructed the central pulmonary artery with a 16 mm porcine pericardial roll to unify the nonconfluent pulmonary arteries. Secondly, about 2 months after the first operation, we performed a modified Fontan operation. Systemic venous return from the inferior caval vein and the hepatic veins were drained to a reconstructed pericardial roll with an intraatrial Gore-Tex graft, and bilateral superior caval veins were also anastomosed to the roll. The structure of the pulmonary arterial system is one of the most important factors to determine the outcome of a modified Fontan operation. Even if the central pulmonary artery is absent, however, a modified Fontan operation is applicable for the patient whose peripheral pulmonary arteries have enough growth.

[The effects of calcium concentration of reperfusion solution upon myocardial protection]

The effects of several calcium concentrations in reperfusion solution were studied. Experimental time course was as followed: 20 min working perfusion, 3 min cardioplegic infusion with St. Thomas cardioplegic solution (STS) followed by global ischemia for 30 min at 37.5 degrees C, 15 min early Langendorff reperfusion with reperfusion solution and 5 min late reperfusion with Krebs Henseleit bicarbonate buffer [( Calcium] = 2.5 mM), followed by 20 min working perfusion. Percent recoveries of aortic flow at the Ca concentration of 0, 0.1, 0.6, 1.2, 1.8, 2.5 mM were 0, 14 +/- 1, 43 +/- 4, 64 +/- 3, 55 +/- 2, 59 +/- 1 (%), respectively. Our data indicated that reperfusion solution with less than 1.2 mM calcium reduced the protective properties of STS.

Harmful effects of inotropic agents on myocardial protection

Using an isolated working rat heart model, the pretreatment effects of positive inotropic agents on ischemia-reperfusion injury were investigated. The experiment consisted of (1) working control perfusion; (2) working perfusion with isoproterenol (I), milrinone (M), a combination of these drugs (I + M) and dibutyl-cyclic adenosine monophosphate (DB) followed by ischemic arrest for 33 minutes at 37 degrees C or 150 minutes at 20 degrees C and Langendorff reperfusion; and (3) working perfusion. Under conditions of normothermic ischemia, percent recoveries of postischemic cardiac output (mean +/- standard error of the mean) in the I, M, I + M, and DB groups were 37.8% +/- 12.7%, 61.3% +/- 3.1%, 0%, and 53.1% +/- 5.2%, respectively. Under conditions of hypothermic ischemia, the percent recoveries in I + M and DB groups were 10.9% +/- 7.9% and 29.8% +/- 9.5%; they were all significantly lower than that in the control group. The addition of diltiazem or ryanodine at several concentrations and lowering of the Ca2+ concentration in the St. Thomas' cardioplegic solution did not prevent I + M-induced injury. Our data suggest that pretreatment by I + M aggravated ischemia-reperfusion injury, and adjustments in Ca2+ concentration were not sufficient to prevent that injury.

An endonuclease activity in human polymorphonuclear neutrophils that removes 8-hydroxyguanine residues from DNA+

An endonuclease that specifically removes 8-hydroxyguanine (oh8Gua) from DNA has been isolated from Escherichia coli. As the amount of oh8Gua produced in DNA of X-ray-irradiated mice is known to decrease with time after irradiation, an attempt was made to find a similar activity in human polymorphonuclear neutrophils (PMNs) using a synthetic dsDNA containing oh8Gua as a substrate. The PMN enzyme was isolated free of other DNases, and found to cleave the substrate DNA simultaneously at 2 sites, the phosphodiester bonds 5' and 3' to oh8Gua, producing free hydroxyl and phosphate groups, respectively. The enzyme showed almost no activity on DNAs containing other kinds of modified base tested or mismatched DNA. Thus human cells also contain an endonuclease that specifically removes oh8Gua residues from DNA.

[Effects of nitroglycerin upon myocardial metabolism after open heart surgery]

The effects of intravenous administration of nitroglycerin (TNG) on hemodynamics and myocardial metabolism after open heart surgery were evaluated in 22 patients without ischemic heart disease. On 12 hours after starting the continuous infusion of TNG at a rate of 0.2 micrograms/kg/min on 10 patients (TNG group), coronary blood flow (CBF) increased (p less than 0.01) and myocardial oxygen metabolism improved remarkably. However, anaerobic metabolism still existed in TNG group and no significant difference between TNG group and Control group even after 12 hour continuous drug infusion. From these studies, it was concluded that the intravenous administration of TNG at a rate of 0.2 microgram/kg/min increased CBF, however did not improve myocardial metabolism after open heart surgery possively probably because of changes in coronary collateral function.

Identification in human genomic DNA of the sequence homologous but not identical to either the histo-blood group ABH genes or alpha 1----3 galactosyltransferase pseudogene

Based on polymerase chain reaction (PCR) and sequencing of the cloned amplified fragments, we identified a homologous sequence to the histo-blood group ABH genes and alpha 1----3 galactosyltransferase pseudogene. The presence of this sequence in human genomic DNA was confirmed by Southern hybridization.

[Entirely suprasellar symptomatic Rathke's cleft cyst]

Two rare cases of entirely suprasellar Rathke's cleft cyst were reported. Case 1. A 62-year-old man was admitted to our hospital on the 14th of January, 1988, complaining of headache and diplopia. A plain skull x-ray showed the sella turcica was normal. CT scan and MRI demonstrated a lesion mass located entirely in the suprasellar cistern. Right frontotemporal craniotomy was performed, and the cyst wall was resected subtotally. Microscopic sections of cyst wall showed ciliated single layer with focal stratified epithelium. Case 2. A 51-year-old man was hospitalized complaining of visual impairment in the left eye. Endocrinological examination showed no abnormalities. CT and MRI demonstrated a lesion mass located entirely in the suprasellar region. Right frontotemporal craniotomy was performed. The mass was opened and a large amount of yellowish fluid was released. Histologically, the specimens were simple ciliated cuboidal epithelium. Postoperative courses of these patients were uneventful. The findings on CT and MRI of the cases located entirely in the suprasellar region were varied. The histopathogenesis and embryological pathogenesis of Rathke's cleft cyst in the literature, particularly the entirely suprasellar type, were discussed.

The effects of several pharmacologic agents upon postischemic recovery

Using an isolated working rat heart model, the effects of DL-verapamil, ryanodine, gabexate mesilate (FOY), recombinant human superoxide dismutase (RH-SOD), and coenzyme Q10 upon myocardial protection were evaluated. Under conditions of normothermic ischemia, all these compounds, except RH-SOD, when added to the St. Thomas' cardioplegic solution at an optimal concentration, showed beneficial effects upon functional recovery and enzyme leakage. In contrast, the above compounds, except ryanodine and FOY, failed to improve the protective properties of the St. Thomas' cardioplegic solution under conditions of hypothermic ischemia. Our results indicate that calcium overload via the calcium channel and calcium-induced calcium release from sarcoplasmic reticulum (SR) may contribute to the onset of ischemic-reperfusion injury. However, under conditions of hypothermic ischemia, calcium-induced calcium release from SR plays a dominant role in calcium overload. Furthermore, intracellular calcium overload may activate proteases and result in the acceleration of myocardial injury.

[The optimal oxygenation of cardioplegic solution--the buffer effect of carbon dioxide and pH control]

A series of studies was undertaken to establish the optimal oxygenation of St. Thomas' Hospital cardioplegic solution (ST). Using an isolated working rat heart model of cardiopulmonary bypass and the cardioplegic arrest the effect of oxygenation of ST were investigated in this study. The effects of oxygenated ST with various O2/CO2 mixture (100% O2, 99% O2 + 1% CO2, 98% O2 + 2% CO2, 95% O2 + 5% CO2) upon post ischemic functional recovery were compared with those of non-oxygenated ST. Under both normothermic and hypothermic conditions, the pH of the St. Thomas' gassed with 99% O2 + 1% CO2 mixture was maintained at 7.8, and this cardioplegic solution showed highest percent recovery of aortic flow. On the contrary, the pH of St. Thomas' cardioplegic solution oxygenated with 100% O2 exceed 9.0 and it showed lethal effect upon postischemic cardiac function. Thus oxygenation of NaHCO3 containing crystalloid cardioplegic solution oxygenated with 100% O2 is rather harmful and the 99% O2 + 1% CO2 gas is the crucial gas mixture for clinical and experimental use with oxygenated ST.

Sugar-nucleotide donor specificity of histo-blood group A and B transferases is based on amino acid substitutions

Four amino acid substitutions (aa 176, 235, 266, and 268) have been found between the coding regions of cDNAs for histo-blood group A and B transferases (Yamamoto F., Clausen, H., White, T., Marken, J., and Hakomori, S. (1990) Nature 345, 229-233). Here we establish the basis of differential affinity of these glycosyltransferases to nucleotide-sugar (UDP-GalNAc or UDP-Gal). On the basis of gene reconstruction experiments and studies of expression in DNA transfected HeLa cells, the third as well as the fourth aa substitutions (leucine and glycine in A and methionine and alanine in B), which were calculated to modify flexibility of the protein, were found to be crucial in determining nucleotide-sugar specificity. The second substitution (glycine in A and serine in B) also affects the specificity. We have also created new enzymes which catalyze the transfer of both GalNAc and Gal, and may provide an explanation of the rare cis-AB phenotype.

[Massive traumatic hematoma localized in the basal ganglia: treatment by CT-guided stereotactic aspiration surgery]

A case of massive traumatic hematoma of the basal ganglia which was treated successfully by CT-guided stereotactic aspiration surgery, was reported. A 6-year-old boy was admitted 2 hours after a traffic accident. He had no neurological focal signs except for disturbance of consciousness on admission. CT scan revealed a massive hematoma in the right basal ganglia. His neurological status gradually deteriorated 6 hours after the trauma and the size of the hematoma increased on serial CT scan. Then, CT-guided stereotactic aspiration surgery was performed and about 15.5 ml of hematoma clot was successfully evacuated. He made an uneventful recovery from the operation and gradually improved. The final outcome was that he showed moderate disability at 3 months after the trauma. The possible mechanism of development of hematoma in this lesion, and indication of CT-guided stereotactic aspiration surgery were also discussed.

Molecular genetic basis of the histo-blood group ABO system

The histo-blood group ABO, the major human alloantigen system, involves three carbohydrate antigens (ABH). A, B and AB individuals express glycosyltransferase activities converting the H antigen into A or B antigens, whereas O(H) individuals lack such activity. Here we present a molecular basis for the ABO genotypes. The A and B genes differ in a few single-base substitutions, changing four amino-acid residues that may cause differences in A and B transferase specificity. A critical single-base deletion was found in the O gene, which results in an entirely different, inactive protein incapable of modifying the H antigen.

Characterization through cDNA cloning of galactoprotein b3 (Gap b3), a cell surface membrane glycoprotein showing enhanced expression on oncogenic transformation. Identification of Gap b3 as a member of the integrin superfamily

Galactoprotein b (Gap b) is a group of glycoproteins of fibroblast cell membranes showing enhanced expression in association with oncogenic transformation (Carter, W.G., and Hakomori, S. (1977) Biochem. Biophys. Res. Commun. 76, 299-308). We purified Gap b3 (one of the Gap b group) to homogeneity from hamster fibroblast NIL cells transformed with polyoma virus (NILpy). Partial amino acid sequence was determined, and the cDNA clones encoding this protein were isolated by oligodeoxynucleotide hybridization. The 5.0-kilobase pair cDNA encodes a protein of 1051 amino acid residues containing a signal peptide (32 residues), a large extracellular domain (959 residues), a transmembrane domain (28 residues), and a short cytoplasmic domain (32 residues). The overall structure of Gap b3 is similar to that of the alpha subunit of so-called integrin receptors in the following respects: (i) presence of metal-binding sequences; (ii) location of a transmembrane domain near C terminus; (iii) matched positions of most of the cysteine residues. This, together with extensive amino acid sequence homology, strongly suggests that Gap b3 is a member of the integrin family. Gap b3 consists of two polypeptide chains (Mr = 110,000 and 30,000), which seem to be proteolytic cleavage products connected by disulfide bonds from a precursor protein. Southern hybridization shows the presence of a single copy gene in mice and humans as well. Northern hybridization analysis shows that the enhanced expression of Gap b3 in transformed cells is due to increased transcription of its message.

[Coexistence of multiple metastatic brain tumors from thyroid carcinoma and cerebral aneurysms]

A 73-year-old woman was admitted with coexistence of multiple metastatic brain tumor and cerebral aneurysm. She has been operated on for a tumor of the thyroid gland 3 years before. Computed tomography (CT) scan revealed well-defined, homogeneously enhanced masses in the left frontal and right posterior temporal region. Right carotid angiography showed a tumor stain supplied by the branch of the fronto-polar artery. Left carotid angiography showed an aneurysm at the anterior communicating artery and a tumor stain supplied by the posterior temporal artery. Total removal of the bilateral tumor and aneurysmal neck clipping were performed simultaneously with bi-frontal craniotomy and right temporal craniotomy in April of 1988. Histology of tumor was papillary carcinoma. The surgical indication and treatment for patients with coexistence of multiple brain tumor and cerebral aneurysm were discussed.

[Extended direct anastomosis for coarctation of the aorta and interruption of the aortic arch]

Between March, 1986 and May, 1988, extended direct anastomosis was performed for coarctation of the aorta (CoA) (5 infants) and interruption of the aortic arch (IAA) (3 infants). The aortic arch was hypoplastic in 3 patients. The incision was made in the inferior aspect of the aortic arch proximal to the origin of the carotid or brachiocephalic artery, which was then anastomosed to the descending aorta. Pulmonary artery banding was placed in 4 patients with associated complex cardiac anomalies. Aortic cross-clamp time was 19-54 minutes (mean 41 minutes). Pressure gradient between upper and lower extremity was 0-10 mmHg (mean 4 mmHg). There were no operative deaths and no neurologic complications. The peak flow velocity at the site of aortic reconstruction measured by Doppler echocardiographic study after surgery was 1.2-2.5 m/sec (mean 1.7 m/sec). This procedure has the advantages of leaving the subclavian artery intact and no aortic shelf tissue. And it can be applied in IAA or CoA with hypoplastic aortic arch.

Isoproterenol and the genesis of reperfusion-induced arrhythmias in isolated rat heart: adrenoceptor or free radical-mediated mechanisms?

In the isolated rat heart, reperfusion-induced arrhythmias were exacerbated by isoproterenol (0.01-1.0 microM). The proarrhythmic action of isoproterenol was primarily the result of a beta 1-receptor-mediated tachycardia rather than via a free radical-mediated process, since it was prevented competitively by the beta 1-receptor antagonist metoprolol, but not by the free radical scavengers mannitol, superoxide dismutase, and catalase. If heart rate was maintained by electrical pacing, the protective action of metoprolol against the isoproterenol-induced arrhythmias was lost. At high concentrations (5 and 50 microM), metoprolol alone produced a bradycardia that was probably not related to beta 1 blockade, and this resulted in some nonspecific antiarrhythmic activity. The data provide evidence that, in this model, heart rate during ischaemia is an important determinant of reperfusion-induced arrhythmias, and that free radical formation from the oxidation of high levels of exogenous isoproterenol present at the time of reperfusion does not contribute in a major way to the detrimental action of isoproterenol.

[Changes in lymphocyte subsets, neutrophil function and complement levels in patients with complications following open heart surgery]

In order to evaluate the immune response during and after open heart surgery, we have studied 34 patients who received open heart surgery under extracorporeal circulation. Age range of these patients were from 41 to 76 years. These patients were divided into three groups, depending upon existence of multiple organ failure (MOF), low output syndrome (LOS) and non-LOS and non-MOF diagnosed from our criteria. The following cytological and immunological study has been performed pre-operatively, immediately after and on 1, 2, 7 and 14th postoperative day; 1) the leukocyte differential cell count, 2) function test of neutrophils, 3) lymphocyte subpopulation and subsets, 4) serum level of complement fractions (C3, C4) and CH 50. By lymphocytes analysis, postoperative early reduction of OKT 3 (CD 3) and OKT 4 (CD 4) was observed in patients with poor prognosis. Patients with the postoperative high activity of NBT reduction test was developed into MOF. Complement activity (C3, C4, CH50) decreased during surgery and recovered to preoperative level in patients without LOS and MOF. However in MOF patients, these values showed lower level than that of patients without LOS and MOF. Our data suggested that lymphocytes and leukocytes tests were useful to evaluate the prognosis in open heart surgery.

Cloning and characterization of DNA complementary to human UDP-GalNAc: Fuc alpha 1----2Gal alpha 1----3GalNAc transferase (histo-blood group A transferase) mRNA

Based on the partial amino acid sequence, the cDNA encoding UDP-GalNAc:Fuc alpha 1----2Gal alpha 1----3GalNAc transferase, the specific primary gene product of histo-blood group A gene (A transferase), was cloned and sequenced. Poly(A)+ RNA from human stomach cancer cell line MKN45, expressing high levels of A antigen, was used for construction of a lambda gt10 cDNA library. Degenerate synthetic oligodeoxynucleotides were used for polymerase chain reactions to detect the presence of the sequence of interest in cDNA (presence test) and to identify the correct clones (identification test) after screening the library with a radiolabeled polymerase chain reaction amplified fragment. Nucleotide sequence analysis revealed a coding region of 1062 base pairs encoding a protein of 41 kDa. Hydrophobicity plot analysis shows the existence of three domains: N-terminal short stretch, transmembranous hydrophobic region, and a long C-terminal domain (a feature common to all glycosyltransferases cloned so far). Southern hybridization analysis has shown that this DNA does not represent a multigene family. No restriction fragment length polymorphism was found to correlate with ABO blood group type. Bands were detected in Northern hybridization of mRNAs from cell lines expressing A, B, AB, or H antigens. These results suggest that sequences of ABO genes are essentially very similar (with minimal differences), and the inability of the O gene to encode A or B transferases is probably due to structural differences rather than A or B transferase expression failure.

[Surgical therapy of congenital aortic valvular stenosis in neonates and infants]

The preoperative evaluation, surgical course, and early follow-up results of 5 infants less than 4 months of age who underwent aortic valvotomy for severe valvular stenosis between 1983 and 1985 were reviewed to determine the early prognosis of these neonates. Two of the 5 patients had been used respiratory support due to severe congestive heart failure and dyspnea. Emergency aortic valvotomy was performed in all during cardio-pulmonary bypass which achieve maximal relief of the stenosis without significant causing aortic insufficiency. There was a single operative death and there was one late death at 2 months after surgery who was regarded to have a extensive endocardial fibroelastosis. The other three patients have had a favorable early prognosis during mean follow-up period of 1.78 (0.4-3.8) years. They had been followed by means of two-dimensional and doppler echocardiography, which inferred that the aortic pressure gradient had been kept under 41 mmHg and which indicated that there were no LV enlargement to prove significant aortic valve insufficiency. These results indicate that early infants with severe valvular stenosis can undergo sufficient valvotomy safely and have a favorable early prognosis.

[The effect of local injection of interferon against human malignant glioma transplanted into nude mice and the mechanism of its effect]

In order to clarify the mechanism of action of recombinant human leucocyte interferon, the effect of local injection of it to the human malignant gliomas (one oligodendroglioma, the other glioblastoma) transplanted into nude mice were evaluated. The volume of the tumors were calculated as 1/2 (short diameter [cm])2 x (long diameter[cm]). And the ratio of tumor volume (T)/original size (C) were calculated in terms of experimental day. Among the groups of control (vehicle of IFN injected), 1 million units of IFN locally injected group, 3 million units injected group, and 9 million units injected group, the effects of the treatment were statistically evaluated in terms of T/C. At the end of the experiment, each animal was injected 4 mg of BrdU intraperitoneally, and the labeling indices of the tumor tissue were measured and compared among the groups above mentioned. Local injection of IFN to the tumor was effective even at the dose of 1 million units every other day for 16 days for glioblastoma and 50 days for oligodendroglioma. The labeling index of the treated groups was significantly reduced when compared to that of control group in both tumors. And the experiment was performed to evaluate the variation of NK activity and ADCC activity of mouse spleen cells among the experimental groups. For the oligodendroglioma, NK activities were significantly increased in the 9 million units of IFN injected group when compared to those of control group. For glioblastoma, there was no definite variation of NK and ADCC activities among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spinal injury in children]

We reported five cases of children with spinal injuries. Spinal injuries are rare in children, and most common from the occiput to C3 in children younger than 8 years. In our cases, two younger children had upper cervical lesions and two older children had lower lesions. These differences result from anatomical characteristics, such as special histological architecture of the growth zones in younger children. One patient had a delayed onset paraplegia without radiographic abnormality. This phenomenon seems to be one of the characteristics of the spinal injuries in children. Because of this, all children with head or neck injuries should be fully investigated. A nine-month-old child who suffered from a fracture of the odontoid process with atlantoaxial dislocation was treated by immobilization only, and the result was good. Generally, fracture of the odontoid process in young children can be treated by proper immobilization. One patient with fracture dislocation of the cervical spine died as a result of cord injury. So immediate surgical decompression is mandatory for patients with evidence of cord compression.

[Evaluation of the contractile state of the left ventricle before and after aortic valve replacement from end-systolic stress-volume relations in patients with chronic aortic regurgitation]

Before and one month after aortic valve replacement, the contractile state of the left ventricles in 10 patients with chronic aortic regurgitation were studied. The slope and intercept of the end-systolic stress-volume relationship (ESSVR) determined by M-mode echocardiography during intravenous infusion of Nitroprusside were used as an index of myocardial contractility. We found that the end-systolic wall stress-volume relationship from more than four points of pressure and dimension data have shown the linear relation for each subject with linear coefficients ranging from 0.848-0.997. There was no significant change in the slope of ESSVR between the pre- and early postoperative studies (1.66 +/- 0.37 to 1.92 +/- 1.02; p greater than 0.05), however, the intercept decreased significantly (44.7 +/- 32.4 to 29.4 +/- 28.0; p less than 0.01), which meant the leftward shift of the line of ESSVR and may imply the improvement of myocardial contractility. On the contrary, the fractional shortening decreased significantly (25.6 +/- 8.5 to 18.9 +/- 8.8%; p less than 0.01), reflecting marked reduction in preload or left ventricular end-diastolic volume (7.52 +/- 1.07 to 6.04 +/- 1.38; p less than 0.01). The change in the slope of the liner of ESSVR demonstrated that myocardial contractility might not be depressed at this time but rather improving.

[A case of primary lung cancer associated with diffuse panbronchiolitis]

Pulmonary resection was performed for primary lung cancer of a 72-year-old patient which was associated with diffuse panbrochiolitis that required home oxygen therapy. The preoperative total pulmonary vascular resistance at rest was 564 dyne.sec.cm-5/m2, but thoracotomy and reduction surgery were possible by strict respiratory and circulatory control. The troublesome postoperative pulmonary phthisis was dealt with through extended control by means of total parenteral nutrition and use of the Heimlich valve.

[External conduit repair with "valved pericardial roll"]

External conduit repair was performed in 20 patients with "valved pericardial roll (VPR)" made of own pericardium (one case) or porcine pericardium (19 cases). Intraoperative measurement of peak pressure gradients across the valve ranged from 0 to 8 mmHg (mean 1), and that from the pulmonary ventricle to the pulmonary artery ranged from 0 to 38 mmHg (mean 20). Re-evaluation of 7 patients one year after surgery shows no increase in the pressure gradient except the first case, in which VPR was made of own pericardium. In pulsed Doppler echocardiographic study, no regurgitation was found in 4 patients, mild in 6, moderate in 4, severe in 1. VPR is functioning well with longest follow up at 16 months.

[Effect of immune response during cardiopulmonary bypass on post-operative infections]

To study the effects of extracorporeal circulation on the post operative infections, the relationship between the influences of the immunologic change during cardiopulmonary bypass (CPB) and post operative change of neutrophilia was evaluated in 52 patients. These patients were divided into two groups: group A (non-infected), 19 patients whose neutrophil count increased within 15,000/microliters in peripheral blood after operation. Group B (infected), 33 patients whose neutrophil count increased 15,000/microliters or more within one week after operation. Immunoglobulins (IgG, IgA, IgM) and complement fraction (C3, C4, CH50) levels decreased significantly during CPB, but there was no significant difference between the two groups. The amount of lymphocyte subsets of helper/inducer T cell and suppressor/cytotoxic T cell showed similar change in both groups. On the contrary the amount of lymphocyte subset of Natural Killer cell showed significant increase in A group during CPB when compared with B group, suggesting immunological activation, however, in the group which showed less than 40% increase of NK cell during CPB, there was significant increase of neutrophils after operation compared with the other group which showed high increase of NK cell. These findings suggested the increased activation of the Natural Killer cell during CPB is a favorable response, especially for preventing infections after operation.

[Follow-up study of coronary artery bypass grafting after Kawasaki disease--early and late postoperative evaluation]

In our hospital, 22 patients with severe coronary arterial lesion after Kawasaki disease underwent coronary artery bypass grafting (CABG) since 1982. The age of the cases at surgery ranged from 1 year to 19 years. Mean age was 8.3 years. Fifteen cases were bypassed using internal mammary artery (IMA) and 5 cases using IMA and autologous saphenous vein (SVG). Two cases were bypassed using only SVG. They have been examined until now by catheterization, by Treadmill test, and by Tl-201 myocardial imaging, around 1 month (Study 1) and around 1 year (Study 2) after surgery for the evaluation of results of CABG. One patient died from acute myocardial infarction 3 months after surgery and one patient shows return of anginal attack due to graft stenosis. Other patients are almost uneventful. In the study 1,20 (100%) IMA were patent, and 7 (88%) SVG were patent. In the study 2, 11 (92%) IMA and 6 (67%) SVG remained patent. Development of left anterior descending artery distal to IMA anastomosis was shown in 8 cases in the study 2. On the follow-up study with TI-201 myocardial imaging, disappearance or decrease of perfusion defect was seen in 7 cases (59%) in the study 1 and 9 cases (75%) in the study 2. On the Treadmill test, disappearance or improvement of ischemic change was seen in 15 cases (88%) in the study 1 and 10 cases (84%) in the study 2. These results suggest that IMA is more preferable for than SVG for young children who has an indication of CABG after Kawasaki disease.