[Anesthetic management of a patient with congenital antithrombin III Deficiency using temporal inferior vena cava filter]

We described the perioperative management of a patient with congenital antithrombin III deficiency using temporal inferior vena cava filter. A 30-year-old man with congenital antithrombin III deficiency was scheduled for artificial head replacement of the hip joint under general anesthesia. He was diagnosed as having congenital antithrombin III deficiency when he had had an episode of venous thrombosis after artificial head replacement of the right hip joint. He had been taking warfarin as an anticoagulant, and it was discontinued three days before surgery. To prevent perioperative thrombus formation, the plasma AT III activity was maintained above 80% before, during and after surgery using AT III concentrates. We also placed the temporal inferior vena cava filter. There was no serious thrombosis or embolism perioperatively. The use of the filter during the perioperative period helped to avoid development of serious thrombosis and embolism.

Enhancement of endothelial nitric oxide production by chenodeoxycholic acids in patients with hepatobiliary diseases

The purpose of this study was to clarify whether physiological concentrations of bile acids could affect endothelial nitric oxide production. We investigated the relationships between clinical concentrations of individual bile acids observed in patients with hepatobiliary diseases and endothelial nitric oxide production induced by each bile acid. Fifteen serum bile acids were measured using high-performance liquid chromatography combined with enzymatic fluorometry in 8 patients with liver cirrhosis, obstructive jaundice, and 8 healthy subjects. The effects of individual bile acids on nitric oxide production were examined in human umbilical endothelial cells by measuring the concentration of NO2- in the cultured medium. NO release in the blood was also determined by measuring the NO2-/NO3- concentration in these patients. In patients with hepatobiliary diseases, the plasma concentrations of chenodeoxycholic acid, ursodeoxycholic acid and cholic acid (free acid, taurine and glycine conjugates) were markedly elevated. Incubation of cells with chenodeoxycholic acid and deoxycholic acid (free acid, taurine and glycine conjugates) enhanced NO2- production in a concentration-dependent manner, while cholic acid (free and its conjugates) did not. The effects of individual bile acids on nitric oxide production were additive. Patients with liver cirrhosis and obstructive jaundice had higher plasma levels of NO2-/NO3- levels than the control subjects. These results suggest that increased plasma concentrations of chenodeoxycholic acid (free, taurine and glycine conjugates) in patients with hepatobiliary diseases may induce endothelial nitric oxide production. Thus, nitric oxide production induced by bile acids may be involved in the pathogenesis of circulatory abnormalities in patients with liver diseases.

[Anesthetic management of two patients with essential thrombocythemia]

We report different methods of anesthetic management in two patients with essential thrombocythemia. Case 1 is a 69-year-old male scheduled for cholecystectomy. His blood platelet counts were maintained between 10 to 40 x 10(4).microliters-1 after myelosuppression therapy. His preoperative blood tests were within normal limits. Since he had no signs of hemorrhage or thrombus preoperatively, an epidural catheter was inserted for intraoperative analgesia and postoperative pain relief. Anesthesia was induced with propofol and fentanyl, and maintained with N2O-O2-sevoflurane. Mepivacaine 1% was injected through the epidural catheter for intraoperative analgesia and buprenorphine was injected through the catheter for postoperative pain relief. His perioperative course was uneventful. Case 2 is an 88-year-old female scheduled for emergency enterectomy. She had had recurrent bouts of thrombosis. Her blood platelet counts were 89.1 x 10(4).microliters-1. Since her preoperative management of thrombocythemia had been poor, epidural anesthesia was not performed. Anesthesia was induced with propofol, and maintained with N2O-O2-sevoflurane. Her perioperative course was uneventful. We conclude that spinal or epidural anesthesia is not contraindicated when preoperative platelet counts and aggregation test are within normal limits in a patient with essential thrombocythemia.

Expression and characterization of a magnetosome-associated protein, TPR-containing MAM22, in Escherichia coli

A magnetosome-associated protein, MAM22, contains a TPR domain (five TPR motifs and one putative TPR motif) that has been known to mediate protein-protein interactions. We expressed the mam22 gene in Escherichia coli and found that the purified MAM22 was reversibly self-aggregated by NaCl. The structural model of MAM22 which has been proposed on the basis of the crystal structure of the N-terminal TPR domain of a human Ser/Thr protein phosphatase suggests the novel hydrophobic colloidal features of MAM22 with TPR motifs.

High-porosity expanded polytetrafluoroethylene grafts for thoracic vena cava replacement with or without an omentum wrap

We previously reported that, in a short-term thoracic inferior vena cava (IVC) replacement, a high-porosity expanded polytetrafluoroethylene (ePTFE) graft (fibril length 60 microm) performed well without altering the short-term patency, and that the healing of the high-porosity ePTFE graft was accelerated by an omentum wrap. The purpose of this study was to examine the long-term performance of the high-porosity ePTFE graft with or without an omentum wrap. Eighteen grafts were placed as a thoracic IVC replacement in dogs. Nine of the grafts were wrapped in an omental pedicle flap while the other 9 were not. At 1 month and 6 months, the grafts were harvested and examined for a pathological analysis. During the observation period, one dog died of a viral infection, while the other 17 dogs survived. At 1 month and 6 months, the patency rates of the 17 grafts were 100% regardless of the presence or absence of an omentum wrap. The healing of the grafts without omentum wrap was incomplete 6 months after implantation; granulation tissue was present in the center of the pseudointima. The grafts healed completely by the addition of an omentum wrap. Our data suggest that, with an omentum wrap, the high-porosity ePTFE graft is fully expected to show a good long-term function.

Neutralization of vascular endothelial growth factor prevents collagen-induced arthritis and ameliorates established disease in mice

Vascular endothelial growth factor (VEGF) is implicated in the pathogenesis of inflammatory joint diseases, including rheumatoid arthritis (RA). To determine the importance of this cytokine in vivo, the effect of administering VEGF-neutralizing antibodies to mice with collagen-induced arthritis (CIA), which has many immunological and pathological similarities to human RA, has been investigated. Either saline, normal rabbit immunoglobulin or anti-human VEGF121 rabbit polyclonal antibody was administered to mice subcutaneously either before the onset of arthritis or after the establishment of clinical disease. Anti-VEGF antibody administered prior to disease onset significantly delayed the development of arthritis and decreased clinical score and paw thickness as well as histological severity. On the other hand, the frequency of occurrence of disease compared to either the control group administered saline or normal rabbit immunoglobulin was not altered. Anti-VEGF antibody also significantly ameliorated clinical and histological parameters even when administered after disease onset. These results indicate a possible therapeutical potential for anti-VEGF treatment in human arthritis.

Enhancement of T helper2 response in the absence of interleukin (IL-)6; an inhibition of IL-4-mediated T helper2 cell differentiation by IL-6

Functional roles of interleukin (IL-)6 in T cell response were investigated. Mice deficient in IL-6 and wild mice were immunized with antigens (myelin oligodendrocyte glycoprotein or methylated BSA) and production of IL-4 and interferon (IFN)-gamma by regional lymph nodes was measured. IL-6 deficiency led to an enhancement of IL-4 and an inhibition of IFN-gamma production. Moreover, polyclonal stimulation of spleen T cells from unimmunized IL-6-deficient mice with anti-CD3 plus anti-CD28 antibodies (Abs) demonstrated an enhancement of T helper (Th)(2)responses. The presence of IL-6, however, augmented IL-4 production but it inhibited IFN-gamma expression by spleen T cells in response to polyclonal stimulation and by antigen-primed spleen T cells in response to re-challenge with the antigen. In contrast, the induction of spleen CD4-positive T cells into Th(2)cells in vitro by the anti-CD3 plus IL-4 was completely suppressed by exogenously added IL-6, whereas Th(1)differentiation of T cells by the anti-CD3 plus IL-12 was not inhibited by the presence of IL-6. Thus, these results indicate that IL-6 physiologically could modulate qualitative T cell response and suggest that it augments Th(1)responses partly through its inhibitory capability of IL-4-induced Th(2)differentiation of naive T cells.

Relative serum amyloid A (SAA) values: the influence of SAA1 genotypes and corticosteroid treatment in Japanese patients with rheumatoid arthritis

OBJECTIVES

(1) To determine whether serum concentration of serum amyloid A (SAA) protein is influenced by the SAA1 allele in Japanese patients with rheumatoid arthritis (RA) as previously shown in a healthy control group; and (2) to analyse what factors, based on such an allelic bias, influence the relative SAA values of those patients.

METHODS

SAA and C reactive protein (CRP) concentrations together with SAA1 genotypes were determined in 316 Japanese patients with RA. The relative SAA values were evaluated as an SAA/CRP ratio.

RESULTS

Comparison of the three SAA1 homozygote groups showed that the SAA/CRP ratio was highest in the 1.5/1.5 group (mean 9.0, p<0.01 v the other two homozygote groups) followed by the 1.3/1.3 group (mean 7.2, NS v the 1.1/1.1 group) and the 1.1/1.1 group (mean 4.0). The SAA/CRP ratio was significantly higher in patients receiving corticosteroids regardless of the presence of allele 1.5. No clear differences in the ratio between patients with or without amyloidosis were found.

CONCLUSION

The SAA1.5 allele and corticosteroid treatment had a positive influence on SAA concentrations in serum. These findings are important when evaluating SAA concentration in inflammatory diseases and when considering the cause or treatment of amyloidosis.

Pediatric caudal block with mepivacaine, bupivacaine or a mixture of both drugs: requirement for postoperative analgesia and plasma concentration of local anesthetics

STUDY OBJECTIVES

To assess the effects of pediatric caudal block using mepivacaine, bupivacaine, or a mixture of both drugs on postoperative analgesia, and to examine plasma concentrations of the local anesthetics after caudal injection.

DESIGN

Prospective, randomized, double-blind study.

SETTING

Operating room and pediatric surgical ward.

PATIENTS

60 ASA physical status I children weighing 10 to 20 kg (26 females, 34 males), and scheduled for inguinal herniorrhaphy.

INTERVENTIONS

Patients randomly received caudal block with 1 mL/kg of mepivacaine 1% (Group M, n = 20), 1 mL/kg of bupivacaine 0.25% (Group B, n = 20), or a mixture of 0.5 mL/kg of mepivacaine 1% and 0.5 mL/kg of bupivacaine 0.25% (Group MB, n = 20) after induction of anesthesia with sevoflurane in 50% oxygen (O2). Anesthesia was maintained with 66% nitrous oxide in O2 supplemented with sevoflurane at an end-tidal concentration of less than 1%.

MEASUREMENTS AND MAIN RESULTS

Postoperative pain scores using a pediatric pain scale and plasma concentration of each local anesthetic were measured. In Group M, four patients required postoperative analgesics within the first 24 hours. However, no patients required postoperative analgesics in Groups B and MB. In Group M, the plasma concentration of mepivacaine of two patients exceeded 5 microg/kg of the level of toxicity. However, these patients did not show any toxic symptoms. Because a mixture of two local anesthetics halves the concentration of each local anesthetic, the plasma concentrations of mepivacaine and bupivacaine in Group MB were significantly lower than those of Groups M and B.

CONCLUSIONS

Pediatric caudal block with a mixture of mepivacaine and bupivacaine is effective for intraoperative and postoperative analgesia.

Sertoli cells inhibited apoptosis of pachytene spermatocytes and round spermatids

Apoptosis in the testis represents an important physiological mechanism that regulates the number of germ cells in the seminiferous epithelium. This apoptosis is believed to be regulated by many factors, including growth factors and cytokines, which appear to suppress apoptosis of the germ cells. In this study, we examined the roles of Sertoli cells on the regulation of pachytene spermatocyte (PS) and round spermatid (RSd) apoptosis with either a co-culture trans-well system or a direct contact system. Apoptosis was detected by low molecular weight DNA fragmentation assay, in situ end labeling, and an LDH assay. In addition, the level of Bcl-2, Bax, and ICE mRNAs in PS and RSd by Northern blot analysis. When PS and RSd were cultured with Sertoli cells in either a trans-well system or direct contact system, the extent of apoptotic DNA fragmentation and LDH level were both significantly lower than those control values. TUNEL staining also revealed the inhibition of apoptosis of PS and RSd when they were cultured with Sertoli cells compared with controls (p <0.05). Moreover, the extent of apoptotic DNA fragmentation and LDH level were significantly lower in the direct contact system than in the trans-well system. TUNEL staining also demonstrated a more decrease in apoptosis of PS and RSd in the direct contact system compared with the trans-well system (p < 0.05). PS and RSd cultured with Sertoli cells exhibited an increase in Bcl-2 mRNA, whereas those cultured with serum-free medium did not show any change. The levels of Bax and ICE mRNAs decreased in PS and RSd cultured with Sertoli cells in comparison with control values. These results suggest that Sertoli cells can prevent apoptosis of germ cells, and that the effect of Sertoli cells on germ cells is mediated by cell to cell interaction or, remote effects of inhibitory factors on apoptosis.

Epizootic outbreaks of gizzard erosion associated with adenovirus infection in chickens

Two outbreaks of gizzard erosion in slaughtered broiler chickens in Japan were examined pathologically and microbiologically. The prevalences of such lesions were 9%-11% and 4%-50% in the affected flocks. Affected chickens had no clinical signs. Group I fowl adenovirus (FAV) serotype 1 was isolated from gizzard lesions. Histologically, gizzard mucosa were necrotic. Intranuclear inclusion bodies were seen in the enlarged nuclei of degenerating epithelial cells of the gizzard. The keratinoid layer in the erosion was edematous and desquamated and contained degenerative cells. Moderate to marked inflammatory cell infiltration was observed in the lamina propria and perivascular connective tissue in the submucosa and muscle layer. Immunohistochemical staining showed evidence of FAV antigens in the intranuclear inclusion bodies within degenerating epithelial cells. Ultrastructurally, numerous viral particles were demonstrated in the inclusions.

Hydroxyapatite-pulp composite fiber sheet bed: A new material for the immobilization of CHO-K1 cells

A new immobilization material for cell culture, ahydroxyapatite-pulp composite fiber (HAPC) sheet bed, was usedto grow CHO-K1 cells. The sheet bed for cell culture wasprepared from HAPC fiber by paper-making techniques. Scanning electron microscopic analysis revealed that the HAPCsheet bed had a structure consisting of piled fibers with spaces 10-200 mum in diameter and a pore surface area of 0.32 m(2) g(-1). Using a 25 x 25 mm(2) squareHAPC sheet bed 0.41 mm in thickness (85 g m(-2) basis weight) for cell culture, CHO-K1 cells grew to a cell densityof 3.7 x 10(7) cells cm(-3) in a 60 mm plastic dish over a 6-day culture period. High-density culture of CHO-K1 cells was successfully performed using the HAPC sheet bed in a 500 ml spinner flask over a 21-day culture period. The HAPC sheet bed, wound around the stirrer paddle, was rotated in the spinner flask in order to supply nutrientsand remove waste products efficiently. The HAPC sheet bedhas a large surface area to support cell growth and there islarge diffusion space inside of the bed. This newautoclavable substrate for anchorage-dependent cells can be easily scaled-up.

Experimental infection of specific-pathogen-free chickens with serotype-1 fowl adenovirus isolated from a broiler chicken with gizzard erosions

Gizzard lesions were formed in specific-pathogen-free (SPF) white leghorn chickens inoculated with fowl adenovirus (FAV). The virus, serotype 1 FAV 99ZH strain (FAV-99ZH), was originally isolated from the gizzard mucosa of commercial broiler chickens exhibiting gizzard erosion with intranuclear inclusion bodies. Five-day-old and 53-day-old SPF white leghorn chickens were inoculated with FAV-99ZH by both oral and ocular routes and then examined at necropsy on days 3, 5, 7, 10, 14, and 21 postinoculation (PI). There were no clinical signs in any of the chickens after the inoculation. Focal gizzard lesions occurred macroscopically, however, in inoculated chickens at several experimental periods. FAV was recovered from tissue samples of the proventriculus, gizzard, pancreas, and rectum by day 10 or 7 PI but was not recovered from liver samples of any of the chickens. These results indicate that FAV isolated from gizzard erosion is able to reproduce gizzard lesions as necrosis and erosion in SPF white leghorn chickens and that it may have a greater degree of tissue tropism in gizzards and other digestive organs than in the liver.

Acute cigarette smoking reduces vasodilative effect induced by sympathetic block in dogs

BACKGROUND AND OBJECTIVES

The aim of this study is to clarify the influence of acute cigarette smoking on vasodilation induced by sympathetic block.

METHODS

We measured mean arterial pressure, heart rate, left brachial artery blood flow (BABF), right femoral artery blood flow (FABF), and plasma catecholamines in dogs to examine the effect of acute cigarette smoking after stellate ganglion block (SGB). The experimental protocol was: (1) Left SGB using 1.0 mL 0.5% mepivacaine without smoking (sham smoking); and (2) left SGB using 1.0 mL 0.5% mepivacaine followed by a single cigarette smoking (nicotine 1 mg) 15 minutes after the block.

RESULTS

SGB induced a significant increase of BABF during the study (baseline, 100%; peak at 10 minutes after SGB, 176% +/- 9%; P <.05) in sham smoking and a significant decrease of FABF from 10 minutes after the block to 20 minutes after sham smoking (baseline, 100%; bottom at 5 minutes after sham smoking, 82% +/- 8%; P <.05). Smoking after SGB induced a significant decrease of BABF 60 minutes after smoking (baseline, 100%; 69% +/- 11%; P <.05) and a significant decrease of FABF during the study (baseline, 100%; bottom at 20 minutes after smoking, 74% +/- 20%; P <.05). Smoking significantly increased plasma norepinephrine and epinephrine through the study.

CONCLUSIONS

Sympathetic block induces a significant increase of peripheral blood flow, but smoking produces a significant decrease in the blood flow in the SGB-induced dilated vessels.

Osmolality dependence of erythrocyte sedimentation and aggregation in a strong magnetic field

In order to specify the major determinant of the magnetic enhancement of erythrocyte sedimentation observed previously, the dependence of erythrocyte sedimentation rate (ESR) on osmolality was measured under a strong magnetic field. Even at hypotonic osmolality, an increase in ESR due to aggregation was observed in plasma solution as compared with that without aggregation in saline solution. However, the magnetic field did not enhance ESR at hypotonic osmolality, when the cell shape was an isotropic sphere (spherocyte). Thus, we narrowed our search to a mechanism that would explain the enhanced ESR found specifically in anisotropic erythrocytes. It was concluded that the major determinant can only work for anisotropic erythrocytes and is a magnetic field-induced increase in an intermembrane adhesive area due to magnetic orientation of anisotropic erythrocytes.

[A case of ventricular tachycardia immediately after electroconvulsive therapy in a schinzophrenic patient]

A 33 year-old man weighting, 93 kg with schizophrenia underwent repeated electroconvulsive therapy (ECT) under general anesthesia with thiamylal 200 mg and suxamethonium 80 mg. On his fourth ECT, he developed ventricular tachycardia (VT) immediately after the treatment under general anesthesia with the same agents. The duration of VT was approximately 30 s. The VT returned to sinus rhythm without any special treatment. We speculate that light anesthesia with a small amount of thiopental associated with release of serum potassium caused by suxamethonium induced increased release of catecholamine by ECT to cause VT. After that incident, the patient underwent ECT six times under general anesthesia with thiamylal 250 mg and vecuronium 8 mg, in combination with preventive injection of magnesium sulfate 20 g without any cardiovascular complications. We conclude that the anesthetic management of patients undergoing ECT under general anesthesia should be paid a careful attention for cardiovascular instability, even if they do not have any heart diseases.

[Anesthetic experience of emergency coronary artery bypass graft operation in a patient with cardioamyloidosis]

A 76-year-old woman with acute myocardial infarction underwent an emergency coronary artery bypass graft operation. She developed cardiac failure and sick sinus syndrome before the surgery because she was with cardioamyloidosis. Therefore, intra-aortic balloon pumping and the pacemaker were used to maintain the hemodynamics prior to the operation. Anesthesia was induced with midazolam 5 mg, morphine 30 mg and pancuronium 5 mg, and maintained with 0.3-0.5% isoflurane in 50% nitrous oxide and 50% oxygen. Morphine 10 mg was also injected during the surgery, and the total dose of morphine 40 mg was administered. The pacemaker at 80 bpm was inserted and mexiletine 0.5 mg.kg-1.h-1 was given to prevent ventricular arrhythmias at weaning from cardio-pulmonary bypass. The surgical operation was successfully performed and the postoperative course was uneventful. A combination of light inhalation anesthesia with narcotics may be a choice for anesthetic management of patients with cardioamyloidosis as this method has less influence on hemodynamics.

High concentration sevoflurane induction of anesthesia accelerates onset of vecuronium neuromuscular blockade

PURPOSE

To investigate neuromuscular block using accelography after administration of vecuronium under sevoflurane 8% induction and maintenance with sevoflurane 2% in adults.

METHODS

Patients were allocated to three groups: (1) group I: anesthesia was induced and maintained with propofol and fentanyl (n= 15), (2) group II: anesthesia was induced with propofol and maintained with N2O(66%)-O2-sevoflurane 2% (n = 15), (3) group III: anesthesia was induced with sevoflurane 8% using a vital capacity inhalation induction and maintained with N2O(66%)-O2-sevoflurane 2% (n = 15). 0.1 mg x kg(-1) vecuronium was used for paralysis three minutes after anesthetic induction and reversed using intravenous 0.04 mg x kg(-1) neostigmine with 0.02 mg kg atropine when the train-of-four (TOF) ratio returned to 25%.

RESULTS

The onset time from initial administration of vecuronium to maximal block in the group III was shorter than that in the groups I and II (139 +/- 35, 193 +/- 35 and 188 +/- 47s, respectively: P < 0.05). The clinical duration from maximal block to 25% recovery of TOF ratio in group II and III was longer than that in the group I (47 +/- 15, 48 +/- 14 and 36 +/- 10 min, respectively: P < 0.05). The reversal times from administration of neostigmine to 75% of TOF ratio in groups II and III were longer than that in the group I (196 +/- 53, 208 +/- 64 and 136 +/- 28s, respectively: P < 0.05).

CONCLUSIONS

Vital capacity inhalation induction of anesthesia with sevoflurane accelerates onset and prolongs duration of vecuronium neuromuscular block compared with propofol-fentanyl anesthesia.

The expression of ion channel mRNAs in skeletal muscles from patients with myotonic muscular dystrophy

We investigated gene expression patterns of ion channels including the apamin-sensitive small-conductance Ca(2+)-activated K(+) (SK3) channel, the adult isoform of the skeletal muscle Na(+) channel (SkM1), the fetal isoform of skeletal muscle Na(+) channel (H1), and the Cl(-) channel (ClC-1) by using the semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) for muscle samples from patients with adult onset myotonic dystrophy (DM), amyotrophic lateral sclerosis, and polymyositis. Patients with DM showed a significant increase in SK3 mRNA but not in mRNAs for other ion channels. The increased expression of SK3 gene in DM did not correlate with H1, the marker of muscle denervation, or the percentage of type 2C fiber, the marker of muscle regeneration.

Structure, expression, and conserved physical linkage of mouse testicular cell adhesion molecule-1 (TCAM-1) gene

Isolation and characterization were performed for cDNA encoding mouse testicular cell adhesion molecule-1 (TCAM-1) using 2908 bases coding for a protein having 548 amino acids (60 kDa). Mouse TCAM-1 protein was found to consist of seven domains for signal sequence, five immunoglobulin (Ig) domains, and the transmembrane plus cytoplasmic domain. TCAM-1 gene and the region linking it to growth hormone (GH) gene located downstream from the TCAM-1 gene were then analyzed. The mouse TCAM-1 gene was 11.6 kb in length with 8 exons; the same as for the 12.0 kb rat gene. The distance from the TCAM-1 to GH gene was 12.5 kb in the mouse genome, and 7.6 kb in the rat. By Northern hybridization, 3.1-kb TCAM-1 mRNA was detected in 17-day testis and would appear present in pachytene spermatocytes and round spermatids.