Mid-term results of bilateral internal thoracic artery grafting

Forty patients underwent coronary revascularization using bilateral internal thoracic artery (ITA) grafts between 1988 and 1992. A total of 111 coronary grafts were performed, or an average of 2.8 grafts per patient. Each patient received bilateral ITA grafts, and in 20 patients an additional 29 grafts were constructed with 18 autologous veins and 11 gastroepiploic arteries. The right ITA was grafted as a free graft in 20 patients. The ITA graft patency rate was 96 per cent (67/70) at the time of hospital discharge. The operative morbidity included 3 reoperations for bleeding, 1 perioperative myocardial infarction, 1 renal failure, 2 postcardiotomy shock, and 1 colon perforation. Two hospital deaths occurred; one due to colon perforation and the other due to postcardiotomy cardiogenic shock. One patient died of cerebral infarction 6 month after the operation. Thirty-four patients were in New York Heart Association functional class I, 2 were in class II and 1 was in class III. Cardiac function evaluated by echocardiography and scintigraphy showed significant improvement postoperatively. These data suggest that the use of bilateral ITA grafts is associated with an acceptable mortality and increases the versatility of arterial grafting.

Monoclonal antibodies that recognize the trisaccharide epitope Gal alpha 1-3Gal beta 1-4GlcNAc present on Ehrlich tumor cell membrane glycoproteins

Monoclonal antibodies were prepared against the trisaccharide Gal alpha 1-3Gal beta 1-4GlcNAc, a sequence which occurs on the surface of Ehrlich ascites tumor cells as well as in thyroglobulin, laminin and a variety of other proteins. This was accomplished by immunizing BALB/c mice with the fraction of Ehrlich cell membrane glycoproteins obtained by affinity chromatography on a Griffonia simplicifolia I (GS I) column which selectively binds alpha-D-galactosyl-terminated structures. Detection of Gal alpha 1-3Gal beta 1-4GlcNAc-specific antibodies was accomplished by employing glycoproteins containing the trisaccharide sequence; fusion with spleen cells from an immunized mouse was accomplished in the presence of polyethylene glycol (PEG1500). An enzyme-linked immunosorbent assay (ELISA) system was used to identify two clones (2.10G and 6.8E), which recognized the desired trisaccharide conjugate. These clones also recognized a thyroglobulin fraction isolated by GS I affinity chromatography and murine laminin, both of which possess the Gal alpha 1-3Gal beta 1-4GlcNAc sequence. Inhibition of antibody-trisaccharide reactivity, examined employing an ELISA assay, revealed that two trisaccharides, Gal alpha 1-3Gal beta 1-4GlcNAc/Glc, were the best inhibitory haptens; Gal beta 1-4GlcNAc (LacNAc), Gal alpha 1-3Gal and Gal beta 1-4Glc (lactose) were poor inhibitors. Indirect immunofluorescence staining of unfixed Ehrlich cells using the monoclonal antibody at 4 degrees C revealed fluorescence over the entire cell surface. Indirect immunogold labeling of semithin and ultrathin sections of aldehyde fixed and Lowicryl K4M-embedded Ehrlich cells resulted in specific labeling of the cell surface and internal structure.(ABSTRACT TRUNCATED AT 250 WORDS)

Circulatory support for patients experiencing postcardiotomy cardiogenic shock: analysis of risk factors for death and long-term follow-up

Over the last 5 years, 12 patients received ventricular assist devices (VADs) while in postcardiotomy cardiogenic shock. There were 7 male and 5 female patients ranging in age from 22 to 73 years (average age, 54). Eight patients underwent surgery for valve replacements, 3 for coronary artery bypass graftings, and 1 for closure of a ventricular septal rupture. The duration of VAD support ranged from 6 h to 9 days (mean, 4.2 days). Ten patients were weaned from the VADs, and 6 survived. Univariate analysis indicated that renal failure, infection, and heart failure had a negative impact on those patients who survived. Multivariate analysis indicated that heart failure, renal failure, and preoperative left ventricular ejection fraction were the most important predictors of hospital death. The 6 survivors were followed for 4 to 42 months (mean, 25 months); 5 were in New York Heart Association (NYHA) Class I, and 1 was in Class II. The cardiac functions in 5 patients who lived over 1 year were assessed by echocardiography. Preoperative and postoperative UCG revealed that ejection fraction and mean velocity of circumferential fiber shortening increased significantly (p < 0.01). Also, the left ventricular diastolic and systolic dimensions decreased significantly (p < 0.05). However, the patients did not show further changes in these parameters during exercise. Eight patients who had double valve replacements were observed for comparison (control group). In the control group, exercise improved cardiac output and mean velocity of circumferential fiber shortening (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Experience with radical operation for lower thoracic esophageal cancer through left diagonal thoraco-laparotomy and right posterolateral thoracotomy]

Two cases were reported in which subtotal thoracic esophagectomy, total gastrectomy, splenectomy and distal pancreatectomy was performed for the lower thoracic esophageal cancer through right diagonal thoraco-laparotomy and left posterolateral thoracotomy. Reconstruction was done with the intrathoracic esophagojejunostomy. Extubation could be done on the 1st postoperative day, and postoperative course was uneventful. It was thought that the approach with left diagonal thoraco-laparotomy and right posterolateral thoracotomy was useful for the easy and complete lymph node dissection from the middle mediastinum to the intra-abdominal cavity.

[The effectiveness of preservation of hepatic arterial blood flow by modified Appleby procedure with reconstruction of the hepatic artery--serial changes in postoperative liver function]

We investigated whether modified Appleby procedure with reconstruction of the hepatic artery can avoid complications due to a decrease in heptic arterial flow which has been comprehended in conventional Appleby's operation. The postoperative liver function of 17 patients undergoing modified Appleby's procedure was compared with that of 16 patients undergoing total gastrectomy and distal pancreato-splenectomy (control group). (1) Anticoagulant therapy was not required during and after operation. The common hepatic arterial flow after vascular anastomosis was 396 +/- 101 ml/min. Postoperative celiac arteriography revealed good patency of anastomosis. (2) There were no significant differences between the modified Appleby group and the control group in any of the blood levels of GOT, GPT total bilirubin and alkaline phosphatase at any point until the fourth postoperative week. In none of the patients in the modified Appleby group, the blood levels of GOT and GPT exceeded 250 IU/l. (3) In the modified Appleby group, ICG-R15 was 4 +/- 1% before operation and 6 +/- 3% at the first postoperative month. These results suggested that modified Appleby procedure enabled us to perform resection according to Appleby's operation safely, without need for preoperative or intraoperative examination about the retrograde blood flow mediated by the gastrodudenal artery.

Hemodynamic changes during laparoscopic cholecystectomy in patients with heart disease

Changes in the hemodynamics and urine output were investigated in 19 patients undergoing laparoscopic cholecystectomy, five of whom had heart disease with the New York Heart Association classification I (n = 1) and II (n = 4). Systemic blood pressure, central venous pressure, pulmonary capillary wedge pressure and cardiac output did not significantly change during the procedure including the establishment of pneumoperitoneum. Urine output 30-60 min after starting the pneumoperitoneum was significantly lower in the patients with heart disease compared to the values before and in the initial phase (0-30 min), and also to the values before and during the procedure in the control group. One patient suffered temporary cardiac decompensation following laparoscopic cholecystectomy which prolonged his hospital stay to seven days. The remaining four patients with heart disease could be discharged on the third or fourth day postoperatively. It is concluded that laparoscopic cholecystectomy is feasible in patients with heart disease but attention should be paid to the possibility of oliguria during prolonged pneumoperitoneum.

[A five-year-survival case in which complete response was recognized after combined chemotherapy using 5-fluorouracil, adriamycin and mitomycin C (FAM) for unresectable gastric cancer]

FAM (5-fluorouracil, adriamycin, mitomycin C) therapy was performed on a 65-year-old man with unresectable gastric cancer. Cancer cells have not been recognized by endoscopic biopsy after the patient's complete response. He is alive without metastasis of recurrence for five years.

A case of pancreatic cyst containing gall sludge

A case of acquired retention cyst of the pancreas containing gall sludge was reported. Gallstones or gall sludge recognized in pancreatic cysts has not been reported. Histological examination suggested that the gall sludge in the pancreatic cyst was caused by the reflux of bile into the pancreatic duct through the papilla of Vater. However, endoscopic retrograde cholangiopancreatography showed no anomalous junction of the pancreatico-biliary ductal system. Crystallization of the components of bile can occur in the pancreas even in a case without anomalous junction of the pancreatico-biliary ductal system.

Effect of left atrial plication for the giant left atrium on left ventricular function

Left atrial plication (LAP) following Kawazoe's method was performed on eight patients with mitral valve stenosis associated with a giant left atrium. To investigate the effect of LAP particularly on left ventricular function, the preoperative and postoperative left ventricular function in these patients were compared. The data were also compared to that of the non-left atrial plication (non-LAP) group with left atrial dimension of 60 mm or over. In the LAP group, there were significant differences between preoperative and postoperative data in the following parameters; New York Heart Association (NYHA) class, cardiothoracic ratio, mean pulmonary arterial pressure (PAP), left ventricular end-diastolic pressure (LVEDP), left atrial dimension, stroke volume index, ejection fraction and cardiac index. On the contrary, in the non-LAP group, there were significant differences between preoperative and post-operative data in the following two factors; NYHA class and PAP. The size of the left atrium in the non-LAP group remained unchanged over the course of long-term follow-up. Despite severe clinical symptoms and severely reduced cardiac function of the patients in the LAP group, cardiac function in all patients improved satisfactorily. This suggests that left atrial plication has a considerably beneficial effect on left ventricular function, and therefore, may be recommended for patients with a giant left atrium.

[Clinical experience of reoperation for anastomotic stricture following proximal gastrectomy for esophageal varices]

A few cases were reported in which second reconstructive operation on gastrointestinal tract for reflux esophagitis following the proximal gastrectomy was performed. But no previous report of the removal of anastomotic region for treating anastomotic stricture due to reflux esophagitis has appeared. Also, there are no reports on second operations to treat anastomotic strictures following proximal gastrectomy for esophageal varices. We report a case in which we obtained favorable results in treating an anastomotic stricture due to reflux esophagitis, which developed following a proximal gastrectomy for esophageal varices, by performing removal of the anastomotic region and resection of the remaining stomach with reconstruction by the Roux-en Y method.

Purification and properties of neuraminidase from the culture medium of Bacteroides loescheii

Neuraminidase was purified from the culture medium of Bacteroides loescheii ATCC 15930 by ultrafiltration followed by a DEAE-Sephacel anion exchange chromatography, fast-protein liquid chromatography using Mono P column and high-performance liquid chromatography using a Shim-pack Diol-300 column. The molecular weight of the purified enzyme was measured to be approximately 87 kDa and the optimal pH was at 4.8. Although the enzyme was able to hydrolyze the substrates with alpha,2-3, alpha,2-6, and alpha,2-8 linkages of N-acetylneuraminic acid, the rate of hydrolysis of N-acetylneuraminosyl-alpha,2-3-lactose was greater than that of the alpha,2-6-isomer.

Inhibitory effects of human salivary histatins and lysozyme on coaggregation between Porphyromonas gingivalis and Streptococcus mitis

The effects of histatins on coaggregation between Porphyromonas gingivalis 381 and Streptococcus mitis ATCC 9811 were investigated by using a turbidimetric assay. The coaggregation activity was significantly inhibited by histatins 5 and 8 and strongly by lysozyme. Tritium-labeled histatin 8 bound to P. gingivalis cells but not to S. mitis cells.

Complete root resorption of an upper central incisor due to ectopic eruption of canine in a deaf-mute child

Unilateral complete root resorption of the permanent central incisor was experienced in a boy with deaf and dumb. Transposition of tooth germ or abnormally directed eruption of the canine caused not only an entire root but a part of enamel resorption. The patient was diagnosed clinically and radiographically as an ectopic eruption of the right maxillary upper canine and then treatments were provided to improve esthetic and functional conditions in terms of eruption guidance. It should be emphasized that the early diagnosis and the subsequent eruption guidance is essential in the patient with these kinds of eruption disorder of the mixed dentition.

Purification and characterization from human parotid secretion of a peptide which inhibits hemagglutination of Bacteroides gingivalis 381

A peptide from human parotid secretion which inhibited hemagglutination of Bacteroides gingivalis 381 was purified by ultrafiltration followed by DEAE-Sephadex A-25 column chromatography and by gel filtration on Sephadex G-25, and then by reversed-phase HPLC. The complete amino acid sequence of the peptide, determined by automated Edman degradation was as follows; Lys-Phe-His-Glu-Lys-His-His-Ser-His-Arg-Gly-Tyr. The peptide contained 12 residues and the charged amino acids predominated with 4 histidine, 2 lysine, 1 arginine and 1 glutamic acid residues, thus being a histidine-rich peptide. The peptide was an active inhibitor of the hemagglutinating activity of B. gingivalis. Specific binding of tritium-labeled peptide to B. gingivalis cells was demonstrated. These results suggest that the histidine-rich peptide may function as a binding domain for the hemagglutinins of B. gingivalis during agglutination.

Relationship between enzyme activities involved in oxygen metabolism and oxygen tolerance in black-pigmented Bacteroides

In this study, the relationship between enzyme activities involved in oxygen metabolism and the degrees of oxygen tolerance in black-pigmented Bacteroides was investigated. All strains of Bacteroides tested possessed the activities of NADH oxidase and superoxide dismutase, whereas the activities of catalase and peroxidases were not detected in the cell-free extracts. There were relatively high correlations between oxygen tolerance and activity of either NADH oxidase or superoxide dismutase. The activity of superoxide dismutase showed a higher correlation with oxygen tolerance than with that of NADH oxidase. Among the species tested, Bacteroides gingivalis showed the highest activities of both the enzymes and was the most tolerant in the presence of oxygen. Furthermore, the activities of these two enzymes increased during aeration of the oxygen-tolerant strain Bacteroides gingivalis 381, but not in the oxygen-sensitive strain Bacteroides denticola ATCC 33185. These results suggest that superoxide dismutase and NADH oxidase might be important for protection of black-pigmented Bacteroides against the toxic effect of oxygen.

Purification and some properties of fucosyltransferase in human parotid saliva

Fucosyltransferase was purified from human parotid saliva by affinity chromatography on GDP-hexanolamine Sepharose, followed by chromatofocusing on PBE 94 exchanger gel. The purified enzyme had the N-acetyglucosaminide alpha 1----4, the N-acetylglucosaminide alpha 1----3, and the glucoside alpha 1----3 fucosyltransferase activities. The molecular weight of the purified enzyme was estimated to be approximately 20,000. These enzyme activities showed identical pH and divalent metal ion dependencies and identical rates of inactivation upon being heated. The paper chromatographic analysis of the fucosylated products by the purified enzyme and the susceptibility of these products to linkage-specific fucosidase digestion indicated that the transferase formed the Fuc alpha 1----4GlcNAc, Fuc alpha 1----3GlcNAc, and Fuc alpha 1----3Glc linkages.

Neutron dosimetry by the spark counting of tracks in boron-doped film

Thin cellulose nitrate films are doped with a boron compound. After thermal neutron irradiation, the films are etched in an aqueous solution of 10% NaOH, at 50 degrees C, for 1.5 hr, during which the 27 microns thick films are reduced to about 7 microns. The etch-pits caused by 10B(n, alpha)7Li reactions are punched twice at 600 V and then counted at 500 V. The ratio of the spark density to the thermal neutron fluence was found to be 1.0 X 10(-4) for a boron concentration of 1%. After due consideration of background counts, a thermal neutron dose of 0.3 mrem (3 X 10(-6) Sv) can be measured with this system.