Permeation from the synovial fluid as nutritional pathway for the anterior cruciate ligament in rabbits

The anterior cruciate ligament of the knee receives its nutrition from a direct vascular supply and by permeation of nutrients from synovial fluid. In order to quantitate the relative importance of these two routes and to compare the anterior cruciate ligament with the medial collateral ligament, we injected [3H]methyl-glucose as a tracer intravenously or directly into the knee in rabbits. Tracer concentrations in plasma, synovial fluid, the anterior cruciate ligament and the medial collateral ligament were analysed by a pharmacokinetic compartment model developed for this study. The contribution of [3H]methyl-glucose permeation from the synovial fluid was calculated at 59.7% in the anterior cruciate ligament and at 18.1% in the medial collateral ligament. We concluded from these results that the nutrition for the medial collateral ligament, which is an extraarticular structure, is provided mainly by its vascular supply. In contrast, synovial fluid permeation is an important transport route for small molecules for the normal anterior cruciate ligament.

Transdermal iontophoretic delivery of triamcinolone acetonide: a preliminary study in hairless rats

Transdermal iontophoretic delivery of triamcinolone acetonide was examined using a commercially available iontophoretic system (Phoresor, Iomed) in hairless rats. A drug electrode containing triamcinolone acetonide 10 mg dissolved in 1 ml of N,N-dimethylacetamide and water (7/3 v/v) was connected to the positive pole of a Phoresor (set at 4 mA) and direct current was applied for 10, 30, or 90 minutes. The amount delivered to the skin tissues increased with time at a constant rate. Even after the drug electrode had been removed, triamcinolone acetonide was retained in the local skin tissues beneath where it had been for about 24 hours after 30 minutes iontophoresis. These results suggest that the iontophoresis with an organic solvent used as a drug vehicle is useful to increase transdermal absorption of compounds that do not dissolve completely in water.

[Clinical treatment with cisplatin (CDDP) in pleural cavity for carcinomatous pleurisy--study of intraarterial concentration]

We investigated the intraarterial concentration of CDDP following continuous hyperthermic pleural perfusion (CHPP, 43 degrees C for 30 to 60 minutes) with 100 mg CDDP diluted in distilled water or saline in 6 lung cancers (2 pleural dissemination, 1 malignant pleural effusion, 3 positive wash cytology), 2 metastatic lung cancer (from breast cancer, 1 rhabdomyosarcoma with pleural dissemination), and 1 metastatic pleural tumor (adenocarcinoma, unknown origin). The level of CDDP was 9.16 to 24.1 micrograms/ml (average 16.1) in perfusion fluid, 0.3 after 5 minutes, 0.41 to 0.85 after 60 minutes and 0.15 to 0.27 (average 0.22) after 24 hours. There were no severe side effects nor any difference in effects by dilution fluid between distilled water and saline. Only 1 patient suffered pleural effusion after this treatment. The results suggested that CHPP with CDDP diluted by saline was effective for prevention and treatment of pleural dissemination.

Serum markers for fibrosis and plasma transforming growth factor-beta 1 in patients with hepatocellular carcinoma in comparison with patients with liver cirrhosis

In order to elucidate collagen metabolism in hepatocellular carcinoma (HCC) tissue, we compared levels of different potential markers of collagen metabolism and plasma transforming growth factor-beta 1 in patients with HCC and in patients with liver cirrhosis. Serum levels of prolyl hydroxylase and the tissue inhibitor of metalloproteinase-1 in patients with HCC were significantly higher than those in patients with liver cirrhosis and increased with the size of the HCC tumour, whereas the serum levels of procollagen type III propeptide and type IV collagen 7S domain were similar in the two groups. In HCC, the increased plasma transforming growth factor-beta 1 levels were closely correlated with serum levels of prolyl hydroxylase and the tissue inhibitor of metalloproteinase-1. These findings suggest that, in HCC tissue, the intracellular biosynthesis of collagen is enhanced, whereas the secretion of procollagen is disturbed and the degradation of collagen is suppressed by the excess production of the tissue inhibitor of metalloproteinase-1. The results also suggest that plasma transforming growth factor-beta 1 plays an important role in the altered metabolism of collagen in HCC.

Prolonged artificial liver support in a child with fulminant hepatic failure

In Japan, liver transplantation from brain dead donors has not yet started. The authors present the first report of a clinical experience with a child with fulminant hepatic failure in whom the combined treatment of plasma exchange and continuous hemodiafiltration using a high-performance polymethylmethacrylate membrane was used successfully to sustain life for a period of as long as 54 days before liver transplantation from a living donor could be performed. The combination of plasma exchange and continuous hemodiafiltration appeared to maintain blood coagulation and level of consciousness effectively. Although the combined use of plasma exchange and continuous hemodiafiltration is still unsatisfactory as an artificial liver support, the authors suggest that this technique may be useful to support the life of a child who awaits liver transplantation.

Clinical significance of serum hyaluronan in patients with chronic viral liver disease

In order to elucidate the clinical significance of serum hyaluronan in chronic viral hepatitis, serum hyaluronan concentrations were measured using a sandwich enzyme binding assay in 115 patients with chronic viral hepatitis. These findings were examined in relation to the results of laboratory liver tests, levels of serum markers for fibrosis and liver histological findings. Serum hyaluronan levels increased with the progress of liver disease, particularly in liver cirrhosis. There were no significant differences in serum hyaluronan levels among the cirrhotic patients according to Child's grade. Multivariate analysis showed that the significant independent predictors of serum hyaluronan were serum aspartate aminotransferase (P = 0.020), serum alanine aminotransferase (P = 0.008), serum cholinesterase (P < 0.001), particularly serum type IV collagen 7S domain (P < 0.0001), and the histological degree of liver fibrosis (P < 0.0001). These findings suggest that elevated serum hyaluronan levels are closely related to the severity of liver fibrosis. We assessed the predictive value of serum hyaluronan in differentiating cirrhosis from chronic hepatitis, constructing receiver operating curves; we found that serum hyaluronan was a better test for diagnosing cirrhosis than serum type IV collagen 7S domain and laboratory liver tests.

Delay of the denervation process in skeletal muscle by sensory ganglion graft and its clinical application

We examined the effects of dorsal root ganglion isografts on the denervation process of skeletal muscle. A segment of sciatic nerve was removed from each of 25 inbred Wistar-Kyoto rats. Fifteen were set aside as controls. In the remaining 10 rats, isogeneic cervical dorsal root ganglia were grafted to the severed distal stump of the common peroneal nerve. Between day 72 and day 286 postoperatively, both controls and recipients were killed after twitch and tetanic tension recording of the extensor digitorum longus was performed. The wet muscle weight and the twitch and tetanic tensions of the denervated extensor digitorum longus in the graft group were significantly greater than those in the control group. The mean area of the denervated tibialis anterior muscle fibers in the graft group also was significantly larger than that in the control group. In electron and light microscopic images, nerve cells along the periphery of each dorsal root ganglion were found surviving with regenerating axons throughout the experimental period. Numerous myelinated axons were observed in the common peroneal nerve of the graft group, and there were significantly more axonal branches in the extensor digitorum longus of the graft group than in the extensor digitorum longus of the control group. Thus sensory nerve fibers from the grafted dorsal root ganglia had certain beneficial effects to slow the denervation process, presumably secreting trophic factors into the denervated muscle. Clinically, we have transferred avulsed dorsal root ganglia in cases of total brachial plexus avulsion directly into denervated skeletal muscle. This procedure, accompanied by nerve crossing procedures, will probably keep denervated skeletal muscle in a better condition until regenerating motor axons from the repair site reach their target muscle.

Comparison of serum 7S fragment of type IV collagen and serum central triple-helix of type IV collagen for assessment of liver fibrosis in patients with chronic viral liver disease

BACKGROUND/AIMS

A competitive radioimmunoassay for serum 7S fragment of type IV collagen (7S collagen) using a polyclonal antibody against 7S collagen and a sandwich enzyme immunoassay for serum central triple-helix of type IV collagen (IV collagen) using two monoclonal antibodies against the pepsin-solubilized type IV collagen may be used as diagnostic aids for liver fibrosis in clinical medicine. We compared the clinical usefulness for assessing liver fibrosis of serum 7S collagen and IV collagen tests in chronic viral liver diseases, and also examined the elution pattern of 7S collagen- and IV collagen-related antigens in serum by gel filtration analysis.

METHODS

Serum 7S collagen and IV collagen levels were assayed in 151 patients with chronic viral liver disease and 30 healthy control subjects.

RESULTS

Gel filtration on the Sephacryl S400HR column revealed that the 7S collagen antigenicity in serum was heterogeneous, whereas the IV collagen antigen in serum was uniform in size. Serum levels of 7S collagen and IV collagen showed increases closely correlated with the severity of liver disease. The abnormal percentage of 7S collagen in three patient groups was similar to that of IV collagen in the corresponding groups. Serum 7S collagen and IV collagen levels were strongly correlated with the histological degree of liver fibrosis; the correlation coefficients were r = +0.675 for 7S collagen and r = +0.665 for IV collagen. When we assessed the ability of each test to detect cirrhosis with a receiver operating curve, the serum 7S collagen test was a slightly better marker than the serum IV collagen test. For the detection of cirrhosis, serum 7S collagen was 83% sensitive and 88% specific at a cutoff value of 9 ng/ml, and serum IV collagen was 80% sensitive and 81% specific at a cutoff value of 160 ng/ml.

CONCLUSIONS

These findings suggested that serum 7S collagen and IV collagen tests are similarly useful for assessing liver fibrosis in patients with chronic viral liver disease, although the former is slightly better for diagnosing cirrhosis than the latter.

Penile replantation after self-inflicted complete amputation: case report

A case of penile replantation is reported in which a 37-year-old man suffered a self-inflicted complete penile amputation. Replantation was successfully performed; at 3 months after surgery, a urethrocystogram demonstrated the absence of urethral stricture. Although complete erection has yet to be obtained, no other functional impairments have been encountered at 7 months after replantation. Reconstruction of the venous system is considered to be one of the most important factors in achieving a successful penile replantation.

Augmented meniscal healing with free synovial autografts: an organ culture model

We examined whether or not free synovial autografts can augment the healing of lesions artificially created in the human knee meniscus in an organ culture model. The effectiveness of free synovial autografts was also compared with that of fibrin glue (Tisseel). In the control group, the accumulation of cellular components increased at the edge of a 4-mm meniscal defect following culture, although no cells were found to invade the defect. In the fibrin glue group, an increased migration of cells into fibrin glue packed into the defect was observed until 4 weeks following cultivation. However, newly formed collagen produced by the cells in the fibrin glue was minimal even 4 weeks after cultivation. In contrast, in the synovial group, newly formed collagen production, as well as cellular proliferation, increased in the grafted synovium with time after cultivation. By 4 weeks, the gap between the edge of the defect and the grafted synovium was bridged by newly formed collagen tissue, indicating improved histologic repair. Our results suggest that free autogenous synovial tissue grafts in meniscal lesions are superior to fibrin glue, and that interpositional synovial autografts to augment repair of meniscal tears in the avascular zone may be clinically useful.

[Preoperative plasmapheresis for lung cancer with multiple myeloma]

A 66-old-male admitted to our hospital was diagnosed multiple myeloma (IgA kappa type, Durie & Salmon stage IIIA) and squamous cell lung cancer (c-T2N0M0 stage I). The function of platelets was within a normal range (11.7 x 10(4)/mm3 and the bleeding time of two minutes), but the function of coagulation was reduced (prothrombin time, 13.1 seconds; activating prothrombin time, 45.1 seconds; and antithrombin III, 65%). The hyperviscosity syndrome was anticipated because of high IgA M protein (6,551 mg/dl). Plasmapheresis with 800 ml of fresh frozen plasma was performed before the left lower pulmonary lobectomy and R1 lymph node dissection. Then the function of coagulation was improved (prothrombin time, 12.6 seconds; activating prothrombin time, 31.3 seconds; and antithrombin III, 75%). IgA M protein was also decreased to 4,696 mg/dl. Postoperative bleeding necessitated a second thoracotomy. The cause of postoperative bleeding was the ablasion of the pleural adhesion due to tuberculous pleuritis as well as bleeding tendency of multiple myeloma. The plasmapheresis performed in this case did not fully improve the bleeding tendency. Cases of cancer complicated with multiple myeloma have been increasing and if an operation is needed, plasmapheresis should be considered. The indication and the extent of hematologic restoration to be achieved should be further investigated.

Survival and development of reimplanted fetal epiphyses. An experimental study

An experiment was undertaken to study the survival and development of fetal epiphyses after excision and reimplantation in rats. The proximal part of fibula in the hindlimb was dissected free from surrounding tissues and then reimplanted again. Of 80 fetuses that were operated on, nine that had been operated on survived to birth. Histological examination on the hindlimbs of these rats at four and six weeks after birth showed that the reimplanted segments survived, and the bony nuclei of the epiphyses were present. Radiographically, at 6 weeks old, secondary centres of ossification at proximal ends of the fibulas could be seen in both operated and normal limbs. These results indicate the clinical possibility of correcting congenital musculoskeletal abnormalities in the future by in utero transplantation of epiphyses.

Serum markers for connective tissue turnover in patients with chronic hepatitis B and chronic hepatitis C: a comparative analysis

BACKGROUND/AIMS

Clinical and pathological differences between chronic hepatitis B and chronic hepatitis C have now been established.

METHODS

To compare hepatic connective tissue metabolism in chronic hepatitis B and C, we determined serum levels of prolyl 4-hydroxylase beta-subunit, procollagen III aminoterminal peptide, type IV collagen 7S domain, the central helix region of type IV collagen, tissue inhibitor of metalloproteinase, and hyaluronan in 55 patients with chronic hepatitis B and 83 patients with chronic hepatitis C.

RESULTS

There were no significant differences in the above markers for connective tissue turnover between the chronic hepatitis B group and the chronic hepatitis C group.

CONCLUSIONS

These results suggest that the accelerated connective tissue metabolism observed in chronic viral hepatitis is independent of the causative virus.

Flap reconstruction in the upper limb

The introduction of the free flap and the regional fasciocutaneous flap has added to the methods of skin defect coverage in the upper limb and avoids the disadvantages of conventional flaps. This paper describes the features and indications of regional axial pattern flaps and free flaps for upper limb skin defects. They can be categorised into flaps in the ipsilateral upper limb and flaps from out of the upper limb. Flaps in the upper limb include the lateral arm flap, the radial forearm flap, the posterior interosseous artery flap, the dorsal metacarpal artery flap, and the digital artery flap. Flaps from out of the upper limb comprise the latissimus dorsi myocutaneous flap, the scapular flap, the groin flap and the hemipulp flap. Criteria for flap selection include the patient's age and health, the condition of the skin defects, the location and size of the defects and damage of the deep structure, the patient's cosmetic demand, the surgeon's technical skill and the facilities in the operating room.

[Bupivacaine-fentanyl continuous infusion is superior to morphine bolus injection in postoperative epidural analgesia]

We compared bolus injection of morphine 51 +/- 9 micrograms.kg-1 (M-S group) with 48 h-continuous infusion of bupivacaine and fentanyl mixture (BF-C group) for postoperative epidural analgesia in 100 patients who had undergone upper abdominal laparotomy. The epidural analgesia was started about 60 min before completion of surgery. The mixed solution, consisting of bupivacaine 48 ml (240 mg), fentanyl 24 ml (1.2 mg) and 0.9% saline (24 ml), was administered at a rate of 2 ml.h-1 by using a 100 ml balloon infuser. Analgesic effects (determined by visual analogue scale, verbal pain scores at rest and with movement, additional requests of other analgesics), comfort and side effects of the epidural analgesia were examined. The evaluation based on postoperative analgesia and comfortable feeling rated higher in the BF-C group compared with the M-S group (P < 0.01 to of 0.05). There were fewer requests for other postoperative analgesics in the BF-C group (P < 0.01 to 0.05). There was no significant difference in side effects between the two groups. The plasma fentanyl concentration in the BF-C group (n = 5) was maintained almost constant for the period from 24 to 49 hours after the start of infusion and was approximately 1.6 ng.ml-1. We conclude that continuous infusion of bupivacaine (2.5 mg.ml-1) and fentanyl (12.5 micrograms.ml-1) at a rate of 2 ml.h-1 is superior to bolus injection of morphine for postoperative analgesia.

Immune response to fresh meniscal allografts in mice

To date, no study of allogeneic meniscal transplantation has investigated both the host cellular immune response and the humoral immune response. Using inbred mice, we examined cellular and humoral immunity to meniscal allografts through the mixed lymphocyte culture reaction and a complement-dependent cytotoxicity test. We also examined the histology of an allogeneic meniscus transplanted subcutaneously. The stimulation index of the mixed lymphocyte culture seen after placing fresh meniscal allografts subcutaneously was not significantly higher than when isograft controls were similarly placed. Following placement of the allografts, no specific antibodies were detected in serum throughout the 24-week period after grafting. Although viable fibrochondrocytes in the allogeneic meniscus decreased in number and lymphocyte infiltration around the allogeneic meniscus was noted at Week 2, no remarkable infiltration of lymphocytes into the meniscus was observed. These results indicate that in our experimental mouse model, a fresh meniscus apparently is not sufficiently immunogenic to induce a systemic reaction. Our results suggest that a fresh allogeneic meniscus can be transplanted without any special treatment to decrease its immunogenicity.

Clinical evaluation of a monoclonal antibody to serum KM01 for the diagnosis of hepatocellular carcinoma

In order to evaluate a monoclonal antibody KM01 which was developed in mice immunized against a human colon carcinoma cell line, serum levels of KM01 and other tumor markers were studied in patients with both hepatocellular carcinoma and liver cirrhosis and in patients with liver cirrhosis alone. The KM01 levels in the sera of 50 patients with hepatocellular carcinoma plus liver cirrhosis and 50 patients with liver cirrhosis were measured using an enzyme immunoassay method and compared with various tumor markers including alpha-fetoprotein (AFP), DUPAN-2, and protein induced vitamin K absence or antagonist-II (PIVKA-II). The mean serum level (+/- S.D.) and sensitivity of KM01 in patients with hepatocellular carcinoma plus liver cirrhosis were 734 (+/- 716) units/ml and 64%, respectively, and they were significantly higher than those of liver cirrhosis patients (P < 0.001). Three out of 9 cases showing negative serum AFP levels had positive serum KM01 levels. Although the sensitivity of serum KM01 level for hepatocellular carcinoma was inferior to serum AFP and plasma PIVKA-II values, the sensitivity of a combination assay of serum KM01 or AFP was increased to 88%. Clinical data of the patients with markedly elevated serum KM01 levels (more than 1000 units/ml) were compared with patients with moderately elevated levels (530-1000 units/ml); serum bilirubin and alkaline-phosphatase were statistically higher in the former group (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of articular defects with meniscal allografts in a rabbit knee model

Deep-frozen allogeneic meniscal grafts for the treatment of articular cartilage defects were performed experimentally. Osteochondral defects 3 mm in diameter were created bilaterally on the medial femoral condyles of 50 Japanese white rabbits. A meniscus was then grafted into the defect in the left knee, and the right knee was left untreated. At various periods from 2 to 24 weeks postoperatively, the rabbits were killed and macroscopic and histologic examinations were performed. Two weeks after operation, the grafted meniscus was bonded to the floor of the defect. After 12 weeks, chondrocytes producing matrix granules was shown by electron microscopy. After 24 weeks, a congruous articular surface was formed. With time, cellular elements infiltrated into the graft from the surrounding tissues, and gradually increased in penetration. Weight bearing in the early stage after operation did not degrade the grafted menisci, and no changes were shown in the opposing cartilage of the tibia. Deep-frozen allogeneic menisci may be useful as a biological implant to repair articular cartilage defects in this model.

Quantitative assessment of the autonomic nervous system activities during atropine-induced bradycardia by heart rate spectral analysis

Using power spectral analysis of heart rate fluctuation, autonomic nervous system activities in bradycardia appearing in the initial phase of atropine administration were evaluated quantitatively in 16 healthy females. Atropine sulfate (10 micrograms/kg), diluted in 100 ml of 0.9% NaCl solution, was intravenously infused at a rate of 0.5 micrograms/kg per min. Electrocardiograms were sampled for 4 min for later analysis before and 0, 5, 10, 15 and 20 min after initiation of atropine infusion. Powers of low (LFC, 0.05-0.15 Hz) and high-frequency (HFC, 0.15-0.4 Hz) components in the power spectrum of R-R interval variations, and the LFC/HFC ratio were determined at each sampling point. HFC power at 0-4 min increased from 1.11 +/- 0.18 ms2 (mean) of baseline value to 1.37 +/- 0.19 ms2 (P < 0.05). The next 5-9-min value of 1.48 +/- 0.14 ms2 was the maximum, and the amount of atropine infused by 9 min was 4.5 micrograms/kg. The HFC powers following this point decreased. The 20-24-min value after 10 micrograms/kg atropine decreased to 0.21 +/- 0.03 ms2 (P < 0.01), which was lower than the previous 15-19-min value of 0.36 +/- 0.04 ms2 (P < 0.01). The LFC/HFC ratios showed no significant change for the initial 9 min of the atropine infusion. However, these ratios at 15-19 min and 20-24 min were increased from 0.50 +/- 0.04 (mean) of baseline value to 0.75 +/- 0.09 and 0.81 +/- 0.09, respectively (P < 0.01). A transient vagotonic state after atropine administration, followed by the well-known vagolytic state, was quantitatively detected by non-invasive spectral analysis of heart-rate fluctuation.

A case of steroid-induced osteonecrosis of femoral condyle treated surgically

The clinical course and the established treatment for steroid-induced osteonecrosis of the femoral condyle have not been clarified yet, mainly because of the limited number of reports. Conservative treatment for steroid-induced osteonecrosis of the femoral condyle has been advocated, because the underlying disease tends to be serious and multiple joints are usually involved. Conservative treatment usually is continued until osteonecrosis becomes extensive and osteoarthritis has progressed enough to justify total knee arthroplasty. Reported here is a case of steroid-induced osteonecrosis of the lateral femoral condyle that, according to preliminary results, was treated successfully with a vascularized bone and periosteal graft.

High intrinsic healing potential of human anterior cruciate ligament. Organ culture experiments

We studied the intrinsic healing capacity of human semitendinosus tendon specimens, comparing them to human anterior cruciate ligament specimens collected at the time of ligament reconstructions, and using an organ culture model. On the day after cultivation, migration of cells and synthesis of collagen fibers were observed in the ligament group with preserved synovium (PS), the ligament group with resected synovium (RS), and the semitendinosus tendon group (ST). Migrating cells and newly-formed collagen fibers were most prominent in the PS group, followed by the RS, and ST groups. When the area occupied by the migrating cells and newly-formed collagen fibers in the prepared hole was measured, no differences were observed between the groups at week 2. However, differences were noted between the ST and PS or RS groups at weeks 4 and 6. Our findings indicate that the human anterior cruciate ligament possesses a high intrinsic healing capacity. It is also suggested that the synovium plays an important role in enhancing ligament healing capacity.

Promotion of sciatic nerve regeneration in rats by a new neurotrophic pyrimidine derivative MS-430

1. The effects of a new neurotrophic pyrimidine derivative of MS-430 on nerve regeneration was examined using Wistar rats whose left sciatic nerve had been subjected to controlled injury. 2. The functional recovery and the packing density of common peroneal nerve axons were significantly enhanced with the administration of 3 mg/kg/day of MS-430. 3. These results suggest that MS-430 is a promising candidate as a neurotrophic drug for clinical use.