[Emergent operation of left atrial ball thrombus associated with mitral stenosis]

A 71-year-old woman with old cerebral infarction and arterial obstruction was admitted with the diagnosis of a free floating ball thrombus in the left atrium associated mitral stenosis. The emergent open heart operation was performed for removal of ball thrombus and mitral commissurotomy. The size of ball thrombus was 4.8 x 4.0 x 3.0 cm. Postoperative course was uneventful.

Cellulose acetate electrophoretic determination of bone alkaline phosphatase activity in healthy subjects and diabetic patients with and without osteopenia

We adapted the electrophoretic method of bone alkaline phosphatase (ALP) determination using neuraminidase from Vibrio cholerae to separate bone and liver ALP on cellulose acetate membrane. Treatment of separator plus serum (1:8, neuraminidase 111 U/l in final) for 10 min at room temperature (25 +/- 1 degree C) and subsequent electrophoresis made it possible to quantify bone ALP activity simply and rapidly. The precision of the data was at the level of CV of 1.6% (within-day) and 4.7% (day-to-day), with recovery rates of 97-103%. The normal range of bone ALP activity depended on age and sex. Seventy-eight diabetes mellitus (DM) patients, excluding those with renal failure, were divided into two groups of those with and without osteopenia with matching of age (+/- 3 years) and sex. Bone ALP (P < 0.001) and total ALP (P < 0.05) activities and urine calcium/creatinine ratio (P < 0.05) were significantly higher in DM with osteopenia than in DM without osteopenia. Therefore, bone formation and absorption may be accelerated in DM with osteopenia in comparison with DM without osteopenia.

Improvement of blood compatibility on cellulose dialysis membrane. 2. Blood compatibility of phospholipid polymer grafted cellulose membrane

The blood compatibility of a cellulose haemodialysis membrane whose surface was grafted with a methacrylate having a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine, was evaluated with attention to platelet adhesion to the membrane surface and complement activation induced by the membrane. When the original cellulose membrane came in contact with platelet-rich plasma for 30 min, numerous platelets adhered to the surface and aggregated. On the other hand, the membrane grafted with 2-methacryloyloxyethyl phosphorylcholine effectively suppressed platelet adhesion and activation. This effect became more pronounced with increasing surface distribution. Especially, the 2-methacryloyloxyethyl phosphorylcholine grafted membranes, whose distribution exceeded 0.27, completely inhibited platelet adhesion, even when the contact time was 180 min. Moreover, the complement activation was also reduced with increased 2-methacryloyloxyethyl phosphorylcholine distribution on the surface of the membrane.

Improvement of blood compatibility on cellulose dialysis membrane. I. Grafting of 2-methacryloyloxyethyl phosphorylcholine on to a cellulose membrane surface

A methacrylate with a phospholipid polar group, 2-methacryloyloxyethyl phosphorylcholine (MPC), was grafted on cellulose membrane for haemodialysis in an aqueous medium using cerium ion (Ce4+) as an initiator. The effects of the concentrations of MPC and Ce4+, and degassing of feed solution on the grafting of MPC on the surface and the membrane properties such as permeability and mechanical strength were examined. The grafted MPC composition depended on the concentrations of both the monomer and initiator in the feed solution. When the grafted MPC distribution was controlled by the monomer concentration, the permeability of the membrane decreased with an increase in grafted MPC distribution. On the other hand, the permeability was not changed from the original membrane's value when the MPC distribution was regulated by Ce4+ concentration. The tensile strength of the membrane did not change during the grafting of MPC and this indicated that the grafting had taken place in the amorphous region of the cellulose. These results suggested that this method is a promising way to improve the blood compatibility of a cellulose membrane without having an adverse effect on the haemodialysis membrane.

Erythrocyte deformability in workers exposed to lead

Erythrocyte deformability and other hematological indicators were determined in 17 male workers exposed to lead at a secondary lead refinery and 13 controls. Blood lead, urine lead, urine coproporphyrin, delta-aminolevulinic acid and erythrocyte zinc protoporphyrin were determined to evaluate the degree of lead exposure in the lead workers above. For the measurement of erythrocyte deformability, the microfilter method was used. The results were summarized as follows: 1. The mean values of blood lead, urine lead, urine coproporphyrin, urine delta-aminolevulinic acid and erythrocyte zinc protoporphyrin levels in lead workers were 53.5 micrograms/100g, 141.4 micrograms/l, 115.9 micrograms/l, 12.0 mg/l and 68.9 micrograms/dl respectively, suggesting a moderate influence of lead exposure. 2. The mean values of erythrocyte count, hematocrit and hemoglobin were significantly lower in lead workers than those in controls. No significant differences were found in the mean values of mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and corpuscular natrium and potassium between lead workers and controls. 3. Erythrocyte deformability was significantly reduced in lead workers compared with controls.

[Congenital bronchomalacia of left main bronchus combined with lobar emphysema, pectus excavatum and right aortic arch--a case report]

One-year-old girl was admitted because of recurrent pneumonia and pectus excavatum. Chest X-ray showed hyperlucency at the upper lung field and infiltrated shadow at the lower field of the left lung. Bronchoscopy and bronchograms revealed marked collapse in a long segment of the left main bronchus during expiration. CT scan showed an emphysematous change and a giant bulla of left lung. Angiogram showed right aortic arch. Sternoturnover was performed at 5 years of age for pectus excavatum. After 10 months, left pneumonectomy was performed for bronchomalacia and lobar emphysema. Pathologic findings of the bronchus revealed that the rings were flattened, while the cartilage was microscopically normal.

A case of lead poisoning recovered by transposition of the work post

A case of lead poisoning in a secondary lead refinery was reported. A 58 year old man working at the post of lead refining complained of severe lassitude and diarrhea. By increased urine coproporphyrin excretion, he was suspected of a case of lead poisoning. Clinical data from the health examinations revealed that he had been affected by lead. The patient was transposed to another work post where lead was not handled and rapidly recovered from the poisoning.

Effect of hypothermic ischemia and reperfusion on calcium transport by myocardial sarcolemma and sarcoplasmic reticulum

The effects of hypothermic ischemia and reperfusion on sarcolemma and sarcoplasmic reticulum Ca2+ transport were studied in vesicles isolated from rabbit hearts. Hypothermic global ischemia was produced by immersing hearts in saline at 4 degrees C for 3 h. Following hypothermic ischemia, reperfusion was carried out for 40 min using a Langendorff perfusion system for the working heart. Na+,K(+)-ATPase activity of sarcolemmal vesicles (SL), was not depressed by hypothermic ischemia nor by ischemia and reperfusion. The initial rate of Na(+)-Ca2+ exchange in SL vesicles was not depressed, but the maximum amount of Ca2+ uptake was increased both after hypothermic ischemia and after reperfusion. Ca2+ uptake activity of sarcoplasmic reticulum vesicles (SR) isolated from hearts subjected to hypothermic ischemia was slightly lower than that of control, and was further reduced following reperfusion. Ca(2+)-ATPase activity of SR was unaffected by hypothermic ischemia, while it was markedly lowered after reperfusion. Although the phosphoenzyme level in SR vesicles was slightly decreased, the turnover rate was reduced after reperfusion. Reperfusion injury thus took place mainly in SR while SL appeared to be tolerant to ischemia and reperfusion.

Reverse vascular pedicle hypothenar island flap

The vascular supply of the skin of the hypothenar region was investigated using 12 cadavers and 24 hands. The ramifications of the proper palmar digital artery of the little finger were also investigated by angiogram in 20 hands. It was found that it is possible to raise the hypothenar skin as an island flap, using the reverse vascular pedicle of the proper palmar digital artery of the little finger. We applied this island flap in three cases. With the result of these anatomical and radiological studies, the details of three cases are described.

Effect of prolonged hypothermic ischaemia on myocardial sarcoplasmic reticular calcium transport

STUDY OBJECTIVE

The aim of the study was to assess the effects of hypothermia on sarcoplasmic reticulum in myocardium subjected to prolonged ischaemia.

DESIGN

Calcium regulatory activity of myocardial sarcoplasmic reticulum was measured in hearts subjected to various periods of hypothermic ischaemia in comparison with hearts subjected to normothermic ischaemia.

SUBJECTS

Hearts (n = 5-9 per experiment) were obtained from male New Zealand white rabbits, 2.0-2.8 kg weight.

MEASUREMENTS AND RESULTS

Calcium uptake and calcium dependent ATPase activity were measured in isolated sarcoplasmic reticulum vesicles after hypothermic ischaemia was produced by immersing hearts in saline at 4 degrees C for 3, 6, or 12 h. Normothermic hearts were immersed for 3 h at 37 degrees C. Calcium uptake and calcium dependent ATPase (Ca-ATPase) activity were markedly inhibited by normothermic ischaemia. In hypothermic ischaemia, calcium uptake was only slightly depressed after 3 h, though longer periods of ischaemia resulted in significant depression of uptake. Ca-ATPase activity was unaffected after 6 h of hypothermic ischaemia. The ratio of calcium uptake to Ca-ATPase activity decreased after 3 h of hypothermic ischaemia. The phosphoenzyme concentration in sarcoplasmic reticulum was unaffected up to 6 h. The ratio of Ca-ATPase activity to phosphoenzyme concentration was not significantly altered until 12 h. Protein composition, examined by SDS-polyacrylamide gel electrophoresis, showed a decrease in 100,000 dalton polypeptide in normothermic ischaemia and after 12 h of hypothermic ischaemia.

CONCLUSIONS

These results suggest that the depression of calcium uptake activity after 6 h of hypothermic ischaemia is likely to be due to uncoupling of calcium transport from ATP hydrolysis. Depressed Ca-ATPase activity at 12 h can be attributed to a reduction in the number of active calcium pump units. Hypothermia preserves function of myocardial sarcoplasmic reticulum during ischaemia for up to 3 h.

[Activity of guanase in serum and liver function tests in HBe antigen-positive chronic hepatitis]

Forty-one patients with chronic hepatitis were divided into an HBe antigen-positive group (n = 13) and an HBe antigen-negative group (n = 28) to clarify the relationship between the presence of HBe antigen and liver function. In the HBe antigen-positive group, the activities of serum alanine aminotransferase (p less than 0.01), aspartate aminotransferase (p less than 0.05) and guanase (p less than 0.01) were significantly higher than those in the HBe antigen-negative group. The correlation coefficient between the HBe antigen titer and guanase activity was 0.528, which was higher than the corresponding values for alanine aminotransferase and aspartate aminotransferase. The determination of guanase activity in serum may be useful for evaluating the clinical severity of HBe antigen-positive chronic hepatitis.

[Omentum in the management of thoracic surgery: especially its application to tracheobronchial surgery]

Omentum is now not only policeman of the abdomen but also of the thorax. We applied omental pedicle flap in the management of 14 patients with thoracic surgery including chest wall reconstruction, empyema, thoracic skeletal infection and tracheobronchial problems. Especially, tracheobronchial reconstruction using omental pedicle flap for the patient combined with lung cancer (T4N2M0 STAGE IIIB) and asthma under steroid therapy was reported. The case was 71-year-old man with complaint of hemosputum. He had 5-6 year history of bronchial asthma with disturbed pulmonary function of % VC 44%, FVC1.0% 37%. Bronchoscopic study revealed the tumor invading the right side of trachea originating from right upper bronchus with histological diagnosis of moderately differentiated squamous cell carcinoma. Preoperatively, he experienced a heavy asthma attack which was controlled by steroid administration. Following extended right sleeve upper lobectomy, we applied omental pedicle flap around the reconstructed portion for the protection of infection, impaired wound healing due to postoperative steroid therapy and strong tension at anastomoses. Postoperative course was satisfactory. We suggest omental pedicle flap is an effective surgical armamentarium in the management of tracheobronchial surgery for the patient with strong anastomotic tension, immunocompromised condition, preoperative irradiation at bronchial stump and use of drug causing delayed wound healing (steroid, anticancerous drug etc).

Measurement of erythrocyte arginase activity and the effect of lead on the activity in vitro

Measurement of arginase activity made by varying the arginine concentration and the reaction time clarified that the amount of urea formed by arginase peaked at the substrate concentration of 150 mmol/l, and increased linearly by 20 minutes. By using discs punched out from a dried blood filter paper prepared from identical human blood sample, the amount of formed urea showed linear increase up to 160 U/g.Hb. The coefficients of variation in ten measurements were 6.1% for the mean activity of 46.2 U/g.Hb and 2.1% for 152.1 U/g.Hb. No decreases in arginase activity were observed when two different dried blood filter papers were left for one week at room temperature. Intact erythrocytes were treated with various concentrations of lead from 0 to 5 mumols/l and their arginase activities were measured. The activity did not elevate linearly with the rise of lead concentration, but an almost diphasic elevation was observed. The arginase activity of erythrocytes treated with 5 mumols/l of lead was higher than that for untreated ones by 32%.

Epidemiological study of occupational exposure to hepatitis B virus and liver function tests

A total of 1020 hospital employees were divided into an exposure group (n = 725) and a non-exposure group (n = 295), based on whether they had been exposed to blood from patients. The HBsAg-positive rates for the exposure and the non-exposure groups were 2.48% and 1.02%, respectively. In the exposure group, the minimal exposure rate increased with age from the twenties. The odds ratios were 7.39 in the technicians, 4.38 in physicians and 1.32 in nurses. Using age-sex matched pairs from the exposure and non-exposure groups, comparison of aspartate aminotransferase, alanine amino-transferase and guanase activities showed that there were significantly higher values in HBsAg-positive subjects (n = 18) from the exposure group than in HBsAg- and HBsAb-negative subjects from the non-exposure group (p less than 0.05-0.01). However, no significant differences were found in the enzyme activities in the matched pairs (n = 89) of HBsAb-positive subjects from the exposure and non-exposure groups.

Morphological change and Raman spectrum of rabbit lens irradiated with ultraviolet laser beam

The effect of ultraviolet rays on eyes was studied. An ultraviolet laser beam (XeCl 308 nm) was irradiated to rabbit eyes to investigate morphological changes of the lens fibers and molecular structural changes of the lens proteins at immediately, 15 days and 32 days after irradiation. 1. Scanning electron microscopic findings of the lens The lens fibers in the control eye were regularly and densely arranged in neat layers of hexahedrons. In the irradiated eye, the fibers at areas that seemed injured were disrupted and the disrupted ends were spherical-shaped. 2. Raman spectra of the lens 1) The relative intensity ratio (I825/I850) of the Raman scattering for the tyrosine residue and the relative intensity ratio (I3390/I2960) of the OH stretching mode (3390 cm-1) of water contained in the lens cortex showed slight changes in the irradiated eye compared to the control eye. 2) The relative intensity ratio (I2572/I2721) of the SH stretching mode (2572 cm-1) for the cysteine residue was 1.05 in the irradiated eye at 32 days after irradiation. It was lower than that in the control eye (1.22 +/- 0.08). This suggested the synthesis of S-S binding by oxidization.

[Effects of grayanotoxin III on liver function and renal function in rats]

The grayanotoxin III (GTX III) was given intraperitoneally to rats at a dose of 0.8 or 2.8 mg/kg. To study the effects of GTX III on rats, biological tests in serum for functions of liver and kidney and their pathological observation were performed 1 h after the administration. Using analysis of variance, multiple comparison and correlation on biological parameters, activities of glutamic-pyruvic transaminase (GPT), guanase and leucine aminopeptidase and concentrations of total protein, albumin, creatinine, uric acid and K increased significantly. These parameters showed dose-effect relations with GTX III. Though GPT and free fatty acid increased significantly, dose-effect relations were not shown. The activity of choline esterase and the concentrations of bilirubin, urea-N, lipoperoxide, cholesterol, triglycerides, Na and Cl were not significantly different. Pathological changes were not observed in the liver and kidney of rats. These results show that GTX III may affect the functions of liver and kidney in rats.

[In vitro susceptibility of bacterial isolates from patients with respiratory tract infections to beta-lactam antibiotics]

In vitro susceptibilities of bacterial pathogens to beta-lactam antibiotics were determined. Bacterial pathogens examined included various isolates from the patients of respiratory tract infections at the hospitals of Kyoto-Shiga area in 1981 and 1983. Major organisms isolated from clinical specimens were Haemophilus spp., Klebsiella spp., Pseudomonas spp., S. aureus and Streptococcus spp. An increase in the isolation frequency of P. aeruginosa, a decrease in the isolation frequency of H. influenzae and no change in the isolation frequency of the other organisms were observed between the years 1981 and 1983. Data from susceptibility tests of clinical isolates confirmed that cefazolin (CEZ) and cefotiam (CTM) showed good antibacterial activity against S. aureus and cefmenoxime (CMX) was highly effective on Streptococcus spp., but that the susceptibilities of both organisms to CEZ, CTM, and cefmetazole (CMZ) in 1983 were lower than in 1981. Although CMX also showed good antibacterial activity against Klebsiella spp., there were no changes in the effectiveness of CTM, CMZ, and CEZ between the years 1981 and 1983. The in vitro antibacterial activities of CMX and cefoperazone against Haemophilus spp. were superior to those of the other beta-lactams tested, but there was a decline in the efficacy for CEZ. Although cefsulodin and piperacillin were highly active against Pseudomonas spp., declines in their effectiveness was observed between the years 1981 and 1983.