Bilateral enlargement of the aortic valve ring for valve replacement in children. New operative technique

We report a new technique for the bilateral enlargement of a small aortic anulus in two children by the insertion of a bifurcated teardrop-shaped Dacron fabric lined with a porcine pericardium. Our experience in two children indicates that this technique will permit the insertion of a prosthetic valve that is four sizes larger than that measured with the native anulus intact in children weighing around 15 kg. It entails no risk of distorting the mitral valve, damaging the conduction system, the main coronary arteries or their important trunks, or of leading to left ventricular dysfunction.

Mucosal lesions of the stomach in liver cirrhosis with a special reference to phospholipid metabolism

Gastric mucosal lesions are an inevitable complication in patients with liver cirrhosis. Their etiology, however, is as yet unknown. The present study investigated phospholipid metabolism in the gastric mucosa of rats with cirrhosis induced by carbon tetrachloride. Gastric mucosal lesions were induced by taurocholic acid (TCA) which was given through a gastric tube. Levels of phospholipids, phosphatidylcholine, and disaturated-phosphatidylcholine were found to be markedly reduced at the mucosal surface in the cirrhotic rats, and they were increased in the gastric juice. Metabolism of phospholipids in the gastric mucosa was visualized by 3H-choline autoradiography and the rate of phospholipid metabolism was found to be reduced. These results strongly suggest that mucosal lesions induced by bile regurgitation into the stomach are due to disturbance of phospholipid metabolism in the gastric mucosa.

[Effects of nasal continuous positive airway pressure (NCPAP) on nocturnal renal function in obstructive sleep apnea syndrome (OSAS)]

Nocturnal renal function was examined in 8 patients with obstructive sleep apnea syndrome (OSAS) and the effects of nasal CPAP (NCPAP) on renal function were also studied. Nocturia was observed more than twice in all cases when no treatment was performed, but it disappeared after initiation of NCPAP. Fractional nocturnal urine volume and creatinine clearance decreased significantly from 1.36 +/- 0.15 ml/min to 0.75 +/- 0.20 ml/min (p less than 0.01) and from 116.8 +/- 46.5 ml/min to 101.1 +/- 33.0 ml/min (p less than 0.05), respectively, after initiation of NCPAP. Although the serum Na and creatinine did not change following NCPAP, the urine Na and creatinine changed significantly after NCPAP therapy. The serum renin, aldosterone, and ADH did not change after NCPAP therapy. The significant positive correlation (p less than 0.05) between the fractional nocturnal urine volume and DI, and also significant inverse correlation (p less than 0.05) between the fractional urine volume and %FRC were observed. These results suggest that the abnormal renal function seen in cases of OSAS is related to the hypoxemia during sleep. It was concluded that the nocturnal renal function in cases of OSAS was different from those in normal controls and NCPAP therapy induced the recovery of these abnormalities.

[Aortocoronary bypass for coronary ostial stenosis following aortic valve replacement: a report of successfully treated case]

A 62-year-old man underwent aortic valve replacement with a Medtronic-Hall valve (21 mm) for aortic stenosis and regurgitation with normal coronary arteries. An intermittent selective coronary perfusion with metal tip cannula was employed for both the coronary arteries. Postoperative course was uneventful. However, he began to complain of chest pain six months later. Cardiac catheterization and coronary arteriography revealed a normally functioning valve with 75% stenosis at the main trunk of the left coronary artery. Coronary bypass grafting using a saphenous vein was successfully performed to the left anterior descending coronary artery and the circumflex of the coronary artery. Whenever this fatal complication of the coronary ostial stenosis is recognized, earlier coronary revascularization should be recommended to save the severely ill patient.

[Surgical treatment for the association of cardiovascular disease and cholelithiasis]

Six cases of the association of cardiovascular disease and cholelithiasis were treated in our surgical ward. Simultaneous operation was carried out for four of them, and two-stage operation was performed in the remaining two cases. As the time of the simultaneous operation, reconstruction of the abdominal aorta and cardiac surgery was firstly done, and cholecystectomy was secondly performed after closing the retroperitoneum or the median sternotomy. All of these cases were discharged from hospital uneventful. In conclusion, cholecystectomy could be safely performed at the same time of the aortic reconstruction and cardiac surgery without any high risk for the patients.

[A case of successful treatment of aneurysms of the suture line following Bentall's operation]

A 33-year-old male who had received Bentall's operation 10 years ago was admitted to our hospital with severe chest pain. The pseudoaneurysm at the right coronary ostium was observed on angiography and CT scan. He underwent the repair of the anastomosis between the graft and the right coronary ostium under extracorporeal circulation. Although he was discharged from the hospital asymptomatically, he was again admitted to our hospital with severe chest pain and back pain 4 months after re-operation. Aneurysmal formation of the ascending aorta due to blood leakage from the distal anastomotic suture line was observed and the graft was compressed by hematoma on angiography and CT scan. He underwent re-operation of the distal anastomosis of the graft, and could be discharged from the hospital uneventfully.

Congenital mitral regurgitation associated with total anomalous pulmonary venous drainage. Report of a rare combination

A case of congenital mitral regurgitation associated with total anomalous pulmonary venous drainage, successfully treated surgically, is reported. To our knowledge, this combination has not been reported in the literature.

Existence of common homologous elements in the transcriptional regulatory regions of human nuclear genes and mitochondrial gene for the oxidative phosphorylation system

Our previous study indicated that nuclear protein factors of HeLa cells specifically bind to three nuclear Mt elements, Mt1, Mt3, and Mt4, located in the 5'-flanking regions of the human nuclear genes for cytochrome c1 and for ubiquinone-binding protein, both of which are subunits of mitochondrial cytochrome bc1 complex (Suzuki, H., Hosokawa, Y., Toda, H., Nishikimi, M., and Ozawa, T. (1990) J. Biol. Chem. 265, 8159-8163). In this study, we examined whether the same nuclear factors could recognize a set of the Mt3 and Mt4 elements that were found in the displacement loop and the promoter region of mammalian mitochondrial genomes. Gel retardation experiments disclosed that the same nuclear protein factors specifically bind to those Mt elements in the human mitochondrial genome as well as to the nuclear Mt3 and Mt4 elements of the two genes, and that the coexistence of both the elements is required for the efficient binding. The nuclear protein factors which recognize the Mt elements located in the regulatory regions of the nuclear and mitochondrial genes may play an important role in coordinate expression of the two physically separated genes during mitochondrial biogenesis.

Effects of dietary zinc and cadmium on tissue selenium concentration and glutathione peroxidase activity in rats fed DL-selenomethionine or sodium selenite

The effects of dietary zinc (Zn) and cadmium (Cd) on tissue selenium (Se) concentration and glutathione peroxidase (GSH-Px) activity were studied in weanling male Wistar rats. One group of rats was fed a purified diet based on casein and sucrose, and the other rats used in a 2 x 2 x 2 factorial arrangement of treatment were fed this diet supplemented with 0.1 mg Se/kg, either as DL-selenomethionine or sodium selenite and plus 100 mg Zn/kg as zinc sulfate or 5 mg Cd/kg as cadmium chloride or both for 4 weeks. Se concentrations in plasma, erythrocytes, muscle, heart, and liver were significantly elevated by Zn. Cd significantly decreased Se concentration in muscle. Addition of Zn to the diets markedly increased (p less than 0.001) hepatic GSH-Px activity. However, Cd in the diets produced a significant increase (p less than 0.001) in erythrocyte GSH-Px activity. These results indicate that Zn level of marginal deficiency (8.6 mg/kg diet) can decrease Se availability and a small excess of Zn increases Se availability for hepatic GSH-Px activity.

Surgical treatment of airway obstruction associated with congenital heart disease in infants and small children

In the last 12 years, 21 patients age 1 month to 5 years (median, 7 months) underwent surgical treatment for severe airway obstruction associated with congenital heart disease. Plico-suspension of the pulmonary artery was carried out in 14 patients with documented severe left bronchial compression by a distended pulmonary artery together with repair of ventricular septal defects (11 patients), repair of large coronary artery fistula (1), division of ductus (1) and pulmonary artery banding (1), with subsequent significant relief of compression. Aortopexy was used in 2 patients with documented severe tracheal compression by a right aortic arch. Five patients had congenital tracheal stenoses (3 extensive, 2 localized). Two of 3 patients with associated complex intracardiac anomalies underwent concomitant repair of both lesions with the use of cardiopulmonary bypass and 1 had a tracheoplasty and pulmonary artery banding. Tracheal reconstruction with a cartilaginous graft together with repair of pulmonary artery sling was carried out in 2 infants. Nineteen patients are alive and well, at a mean follow-up of 87 months. In conclusion, we advocate early aggressive surgical intervention to both lesions to obtain a better result in the management of infants and small children with this difficult and often fatal combination.

[An autopsy case of adult T-cell leukemia complicated with metastatic calcification of the lung]

46-year-old male patient was born in Niigata Prefecture and thereafter lived in Tokyo. In late January 1985, he noticed swelling of the bilateral inguinal lymph-nodes followed by fever and lumbago. In February, he consulted a local doctor and hepatosplenomegaly, marked leukocytosis and renal dysfunction were pointed out and he was referred to our hospital on February 22nd. The clinical laboratory data on admission were as follows; WBC 23,200/microliter, serum-Ca 18.4 mg/dl, BUN 85.3 mg/dl, creatinine 5.4 mg/dl, antibody to ATLV x160. ATL was diagnosed by biopsy of lymph nodes and examinations of peripheral blood and bone marrow hemogram. Remission was achieved in March by the treatment with adriacin. Renal failure and hypercalcemia also improved. However his respiratory dysfunction gradually worsened. The chest radiographies++ showed pulmonary edema, although there was no clinical evidence of heart failure. When his condition became stable, TBLB was performed and revealed extensive deposition of calcium along alveolar septae, suggesting that pulmonary edema was induced by the metastatic calcification of the lung. After the second treatment for ATL, he died of pneumonia. The autopsy showed calcium deposition not only in the lung but in pyramids of the kidney and in sub-serous layer of the small intestine. There was no tumor cell invasion into the bone or parathyroid gland. High urinary c-AMP together with normal levels of PTH suggested that the hypercalcemia in this case was induced by PTH-related protein. It was concluded that careful treatment for hypercalcemia is important as regards the occurrence of pulmonary edema.

Flavonoids inhibit the expression of heat shock proteins

Cells exposed to several forms of stress, such as heat shock, transiently synthesize a group of proteins called heat shock proteins (hsps). Although many stressors other than heat shock are known to induce hsps, inhibitors of hsp expression have never been reported. Here we show that quercetin and several other flavonoids inhibit the synthesis of hsps induced by heat shock in two human cell lines, Hela cells and COLO320 DM cells. Quercetin inhibited the induction of hsp70 at the level of mRNA accumulation. This is the first report to describe the inhibition of hsp expression by reagents.

The specificities of yeast methionine aminopeptidase and acetylation of amino-terminal methionine in vivo. Processing of altered iso-1-cytochromes c created by oligonucleotide transformation

The specificities of methionine aminopeptidase and amino-terminal acetylation in the yeast Saccharomyces cerevisiae were investigated in vivo by sequencing a series of altered iso-1-cytochrome c. Twenty iso-1-cytochromes c, each having a different penultimate residue in the sequence Met-Xaa-Phe-Leu-, were created by transforming yeast directly with synthetic oligonucleotides. The degree of methionine cleavage and amino-terminal acetylation was estimated from the levels of pertinent peptides separated by high performance liquid chromatography. The results confirmed our earlier hypothesis (Sherman, F., Stewart, J. W., and Tsunasawa, S. (1985) BioEssays 3, 27-31) that methionine is completely removed from penultimate residues having radii of gyration of 1.29 A or less (glycine, alanine, serine, cysteine, threonine, proline, and valine). However, only partial cleavage occurred in the sequences Met-Thr-Pro-Leu- and Met-Val-Pro-Leu-, demonstrating that proline at the third position inhibits methionine cleavage when the penultimate residue has an intermediate radius of gyration. Acetylation of the retained amino-terminal methionine occurred completely with the Ac-Met-Glu-Phe-Leu- and Ac-Met-Asp-Phe-Leu- sequences and partially with the Ac-Met-Asn-Phe-Leu-sequence. Although the consensus for acetylation of the retained amino-terminal methionine is not completely known, these results and the results of published sequences indicated that Ac-Met-Glu- and Ac-Met-Asp- (methionine followed by an acidic residue) is sufficient for amino-terminal acetylation in eukaryotes but not in prokaryotes.

A rare case of renovascular hypertension due to iatrogenic thoracoabdominal aortic dissection. A report of successful surgical treatment in childhood

Renovascular hypertension due to iatrogenic thoracoabdominal aortic dissection in an 8-year-old girl with aortic valvular stenosis is presented. A splenorenal arterial anastomosis without splenectomy was successfully performed. This procedure is considered best suited for children with thoracoabdominal aortic dissection as the autogenous graft is expected to grow and provide long-term patency. The spleen left in situ was expected to be advantageous, from the immunological aspect, at the time of open heart surgery for aortic valvular stenosis, which was anticipated in the near future in this child.

[Partial closure of the atrial septal primum defect and biventricular repair for a case of hypoplastic right ventricle with partial atrioventricular canal defect]

An eight-year-old girl with partial atrioventricular canal defect and hypoplastic right ventricle was treated successfully by a palliative open-heart surgery. The preoperative right ventricular pressure was 58/7 mmHg (RVP/LVP = 0.67) and morphology of the right ventricle showed severe tricuspid stenosis and small outflow portion. The preoperative RVEDVI was 31 (41% of normal and tricuspid annulus was 17 mm (47% of normal). The right ventricular outflow was reconstructed with insertion of MVOP and the ASD was partially left open (the amplitude of the interatrial communication was 7 mm). Angiocardiogram two and half years after the operation demonstrated significant right ventricular growth with no right to left shunt through interatrial communication. The RVEDVI was 46 (56% of normal) and tricuspid annulus was 36 mm (90% of normal). This technique can be a procedure of choice in patient with right ventricular hypoplasia, who is not candidate for simple right ventricular reconstruction nor Fontan procedure, as the growth of the right ventricule is expected in the future.

[Cor triatriatum associated with coarctation of the aorta and VSD]

A case of cor triatriatum associated with coarctation of the aorta (CoA) and VSD is reported. A 4-month-old boy underwent subclavian flap aortoplasty and ligation of PDA with the diagnosis of CoA and VSD. At the age of 1 year and 2 months, echocardiography revealed an abnormal subdividing membrane in the left atrium. Under the definite diagnosis of cor triatriatum (Lucas & Schmidt type I B1) and VSD, complete removal of the abnormal septum, patch closure of ASD and VSD was performed with the aid of cardiopulmonary bypass, blood cardioplegia and topical cardiac cooling. Postoperative course was uneventful and the patient was discharged from the hospital on the 38th postoperative day. An association of cor triatriatum, VSD, and coarctation of the aorta is very rare, and to our knowledge, the case presented here seems to be the first report of successful total correction by a staged approach in the literature.

[Successful correction of truncal valve regurgitation and conduit obstruction after previous Rastelli operation for truncus arteriosus (type I)]

A 9-year-old boy had a successful surgical correction of truncal valve regurgitation and obstruction of extracardiac conduit which ensued previous Rastelli operation. He underwent Rastelli operation at the age of 10 months with the diagnosis of truncus arteriosus (Collet & Edwards Type I). At the age of 8 years, he was admitted because of slow weight gain and cardiomegaly (CTR 64%). Cardiac catheterization showed elevated RV pressure, increased pressure gradient across the conduit and severe truncal valve regurgitation. The extracardiac conduit was replaced with a 22 mm Hancock valved conduit and the truncal valve with 23 mm St. Jude Medical aortic valve. Postoperative catheterization revealed a normal RV pressure, only slight pressure gradient across the conduit and no truncal valve regurgitation. He is doing quite well 2 years after the operation.

Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan

A total of 267 infants and children who underwent the arterial switch operation for transposition of the great arteries in the 6 years before Jan. 1, 1988 in six main Japanese institutions were entered into this review. The current status of patients surviving more than 1 year after the operation were evaluated along with early operative results. One hundred forty-six patients had an intact ventricular septum, 103 had a significant ventricular septal defect, and 18 had so-called Taussig-Bing anomaly of the transposition type. Eighteen patients were less than 28 days of age, 73 were 1 to 5 months of age, and 176 were older than 6 months of age at the time of operation. The overall mortality rate was 35% in the first 3 years and 12% in the more recent 3 years. There was a significant difference between the overall mortality rate of primary and two-stage repair (22% versus 10%, p = 0.047) in patients with intact ventricular septum. The overall mortality rate in patients with type B or C coronary arteries of Yacoub, and Radley-Smith's classification was significantly higher than that of other types of arteries (86% versus 18%, p = 0.0001). A total of 156 patients survived more than 1 year after the operation, and 44 children (28%) were noted to have supravalvular pulmonary stenosis (greater than 20 mm Hg). This complication was more common in patients operated on in the newborn period. Trivial or mild aortic regurgitation was noted in 29 patients (19%) and was more common in patients with two-stage than with primary repair (24% versus 14%). Aortic regurgitation was significantly more prevalent in patients in whom coronary arteries were implanted into slits or U-shaped defects than in those whose arteries were implanted into punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049). Normal sinus rhythm was present in 97% of 154 patients and left ventricular ejection fraction was within the normal range in 97% of 115 patients at catheterization 1 to 5 months after the operation.

Growth advantage by overexpression of normal Harvey ras proto-oncogene in cultured rat epidermal keratinocytes

The ras proto-oncogene is frequently amplified and overexpressed in the hyperproliferative conditions of epidermal keratinocytes. To investigate the effects of its overexpression on the growth of keratinocytes in a model system, we constructed expression vectors for normal human Ha-ras and introduced them into FRSK cells, a fetal rat epidermal keratinocyte cell line. Several clones containing the transfected Ha-ras were isolated, and two of them overexpressed this gene. In these clones DNA synthesis and cell growth were greater than in other clones expressing this gene at low levels. Thus we suggest that overexpression of normal ras gene may provide growth advantage to epidermal keratinocytes.

Concomitant repair of congenital tracheal stenosis and complex cardiac anomaly in small children

Severe obstructive lesion of the trachea combined with complex congenital cardiac anomaly has generally been regarded as a fatal disease. Herein we report the successful concomitant repair of severe tracheal stenosis and complex cardiac anomaly with the use of cardiopulmonary bypass in two cases. The first patient was a 5-year-old boy with tetralogy of Fallot associated with a localized intrathoracic tracheal stenosis caused by complete cartilaginous rings. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was performed with the aid of cardiopulmonary bypass. The second patient was a 5-month-old girl with a pulmonary artery sling, scimitar syndrome, and extensive tracheal stenosis. The patient underwent definitive correction of cardiac lesions and complete tracheal reconstruction with a cartilaginous graft with the aid of cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. Both of the patients are doing well at present without any signs of complication, 2 years 5 months and 1 year 10 months after the operation, respectively. We advocate concomitant repair of both lesions, with cardiopulmonary bypass, in the surgical managements of infants and small children who have a difficult and otherwise fatal combination of complex congenital cardiac anomaly and severe intrathoracic tracheal stenosis.

Effect of fish oil and safflower oil in common Japanese diet on human plasma fatty acid composition

The influence of fish oil and safflower oil contained in the common Japanese diet as the main dietary polyunsaturated fatty acid source on plasma fatty acids in ten female student volunteers (21-22 years old) was investigated. The subjects were divided into two groups and fed the experimental diets for five days. The total daily fat intake in the fish diet and safflower oil diet was 54.4 g and 56.2 g, respectively, and the fat derived from fish and safflower oil was 16 g and 23 g, respectively. The proportion of linoleic acid was reduced in the plasma of subjects fed the fish diet and increased in the plasma of subjects fed the safflower oil diet. The plasma levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were significantly elevated in the fish diet group. The ratio of EPA/arachidonic acid (AA) was higher, and those of n-6/n-3 and n-9/n-3 were lower in the plasma of subjects fed the fish diet when compared to the results obtained from plasma of subjects fed the safflower oil diet. From these results, it seems likely that fish oil in the common Japanese diet is a favorable source of plasma EPA and DHA even in such short term supplementation and with such a small amount of daily consumption.

[Mitral valve replacement in 12-month-old infant with parachute mitral valve associated with ventricular and coronary sinus septal defect]

A 12-month-old infant, weighting 6.7 kg, underwent mitral valve replacement with a 17 mm Björk-Shiley prosthetic valve for parachute mitral valve, and patch closure of the associated ventricular and coronary sinus septal defects. Progressive pulmonary artery hypertension and heart failure required surgical intervention. The diagnosis of parachute mitral valve and associated lesions was established by echocardiogram and angiogram. Postoperative recovery was uneventful and he is doing well 3 years after the operation. To our knowledge this is the first successful case to be reported in the literature with such combination of the congenital anomalies.

[Long-term result of total correction of tetralogy of Fallot]

Long-term result of total correction of tetralogy of Fallot was investigated in 51 patients who underwent operation at least 10 years previously. Ninety percent of the patients who responded to the questionnaires expressed his daily life as satisfactory and 4% of the patients had no exercise limitation even in strenuous sports like swimming and running. It was disclosed that the exercise capacity in long-term period was thought to be prescribed by the developmental state of the pulmonary vascular bed at the time of operation which was expressed by the preoperative hemoglobin level and the PA/Ao diameter ratio and no correlation was found with the RV/LV pressure ratio recorded immediately after correction. Three patients died after discharge, 2 years, 2 years and 6 months and 21 years after operations respectively and the cause of death was supposed to be arrhythmia. In case of postoperative complete right bundle block associated with an extreme right axis deviation or left axis deviation, prophylactic pacemaker implantation was recommended.

[Clinical evaluation of various methods of myocardial protections during open heart surgery in infants with ventricular septal defect and severe pulmonary hypertension]

The effectiveness of various methods of myocardial protection were evaluated retrospectively in 59 infants less than 12 months of age who underwent open heart surgery for ventricular septal defect with severe pulmonary hypertension. Intermittent aortic clamping and electrically induced ventricular fibrillation (EF) were employed in 13 infants (Group I), and potassium induced cold cardioplegia and topical cardiac cooling (TC) were used in 14 infants (Group II). Six infants in Group II had additional EF after declamping of the aorta (Group II-A) but the rest of Group II infants did not have any EF (Group II-B). Profound hypothermia and circulatory arrest were utilized in 17 infants (Group III). Cold blood cardioplegia with TC were used in 15 infants (Group IV). Moderate hypothermia were used during cardiopulmonary bypass in Group I, II and IV. The operative mortality for Group I was 15% and was 0% for Group II, III and IV. The incidence of spontaneous resumption of cardiac beat following declamping of the aorta were 33.3, 0, 100, 94.1, 93.3% for Group I, II-A, II-B, III and IV respectively. The urinary output obtained in the postoperative 72 hours was significantly lower in Group I than in Group II, III and IV (Group I less than II less than IV less than III).(ABSTRACT TRUNCATED AT 250 WORDS)

Inhibitory effect of quercetin on the synthesis of a possibly cell-cycle-related 17-kDa protein, in human colon cancer cells

Quercetin inhibits growth of COLO320 DM cells, derived from a human colon cancer. The inhibitory effect is partially reversible when quercetin is removed from the culture medium. Flow cytometric analysis has revealed that quercetin causes perturbation of the cell cycle, inducing a frozen cell-cycle pattern and a block at the G1/S boundary. The synthesis of a 17-kDa protein was specifically inhibited by the addition of quercetin, and recovered when the cells at the G1/S boundary progressed into S-phase after the removal of quercetin from the culture medium. Furthermore, using synchronized cells obtained by centrifugal elutriation, we have shown that the rate of synthesis of a 17-kDa protein was low in G1, and high in S-phase of the cell cycle. Thus, this protein appears to be cell-cycle-related.

[Cell proliferation in a triple gastric cancer--a study using the isolated organ perfusion system]

So as to study the cell proliferation in a case with triple gastric cancers, we labeled an operated whole stomach with bromodeoxyuridine (BrdU) by the isolated organ perfusion system using artificial blood. Anti-BrdU immunohistochemical staining of sections from every part of the stomach was performed, and 3 separated cancerous lesions were all diagnosed as well differentiated adenocarcinomas. The labeling index (L.I.) of the cancerous lesions were found to differ from part to part. However, the L.I. tended to be higher in the superficial mucosal areas and in the cell-dense areas of the submucosa. In the almost normal fundic glands, the labeled zone was localized in the neck of the glands. The more metaplastic gastritis was advanced, the more the labeled zone shifted irregularly toward the bottom of the glands. Whenever the interstinal metaplasia was completed, the labeled zone was localized in the bottom of the glands. This method was found useful in studying the cell proliferation in the stomach without causing any harm to the human body.

Common protein-binding sites in the 5'-flanking regions of human genes for cytochrome c1 and ubiquinone-binding protein

The single nuclear gene encoding human ubiquinone-binding protein, a subunit of the cytochrome bc1 complex, was isolated previously (Suzuki, H., Hosokawa, Y., Toda, H., Nishikimi, M., and Ozawa, T. (1989) Biochem. Biophys. Res. Commun. 161, 371-378). The 5'-flanking region contains four putative CCAAT boxes, one putative NF-Y-binding site, and one sequence homologous to the AP-1 recognition site, but lacks typical TATA and GC boxes. Three common nucleotide sequences (5'-TATTCAGGT-3', 5'-ATCTGGCT-3', and 5'-TGGTGA(T/G)AG-3', designated Mt1, Mt3, and Mt4, respectively) were found in the 5'-flanking regions of the genes for human ubiquinone-binding protein and for human cytochrome c1, another subunit of the cytochrome bc1 complex. All three sequences are located in the 280-base pair BamHI-HindIII fragment of the ubiquinone-binding protein gene and in the 154-base pair SalI-PstI fragment of the cytochrome c1 gene. Interestingly, a computer-assisted homology search revealed that the SalI-PstI fragment of the cytochrome c1 gene is related to the long terminal repeat of an endogenous retrovirus. Sequences highly homologous to the three Mt-sequences were also found in the 5'-flanking regions of the genes for the beta subunit of human F0F1-ATPase and rat somatic cytochrome c. The Mt1 sequence (TATT-CAGGT) is similar to the GFII recognition site (RTCACGTG) found in the 5'-flanking regions of the yeast nuclear genes for three cytochrome bc1 complex subunits. Gel retardation assay demonstrated that protein factors in a whole HeLa cell extract bound to both of those fragments. At least three different specific binding sites were thought to exist in the fragments. Specific binding of the protein factors to the sites, possibly to the three Mt sequences, may play an important role in the coordinate regulation of the transcription of nuclear genes encoding subunits responsible for mitochondrial oxidative phosphorylation.

[Two cases of budgerigar breeder's lung]

We report 2 patients with Bird breeder's lung associated with keeping budgerigars. Patient 1 kept a budgerigar indoors for 13 years. Histological examination revealed fibrosis and granulomatous changes in the alveolar septa. Among T lymphocyte subsets in BALF, helper T cell were increased. In the serum, precipitating antibodies to budgerigar dropping extract were observed. Patient 2 had kept Budgerigar for 7 months. Histologically, alveolitis was the primary finding, and suppressor T cell in the BALF were increased. Precipitating antibodies to budgerigar dropping extract was observed only in the BALF but not in serum. In patient 1 who showed a chronic course and granuloma formation, helper T cell in the BALF were increased while in patient 2 who showed an acute course and alveolitis, suppressor T cell in the BALF were increased, and precipitating antibody was observed only in the BALF. These findings suggest that T lymphocyte subsets in the BALF differ depending on the stage of hypersensitivity pneumonitis, and specific local antibody production precedes systemic antibody production.

Isolation and characterization of a cDNA for rat liver cysteine dioxygenase

Cysteine dioxygenase is a key enzyme of cysteine metabolism in mammals. The cDNA clones for rat liver cysteine dioxygenase were isolated by immunological screening and plaque hybridization from a rat liver cDNA library. The longest clone contained an insert of 1458 bp and encoded a polypeptide of 200 amino acids. The clone included the corresponding nucleotide sequence to amino acid sequences obtained from four lysyl endopeptidase-digested fragments of purified rat liver cysteine dioxygenase. The calculated molecular weight of rat liver cysteine dioxygenase was 23,025. Northern blot analysis revealed a single cysteine dioxygenase mRNA species of about 1.7 kb. A computer homology search indicated that this protein showed no homology with any known protein.

Cor triatriatum, coarctation of the aorta, and ventricular septal defect: a rare, surgically correctable anomaly

A case of cor triatriatum associated with coarctation of the aorta and ventricular septal defect, successfully treated surgically by a staged approach, is reported. This combination is a very uncommon but potentially correctable cause of congestive heart failure and death in infancy. Early accurate diagnosis aided by an awareness of this combination and prompt surgical correction should yield excellent long-term results.

Computed tomography and angiogram of primary hepatic rhabdomyosarcoma: report of two adult cases

Two adult cases of primary hepatic rhabdomyosarcoma, one of which was associated with hepatocellular carcinoma and had double malignant tumors, are described with emphasis on the radiologic features. On precontrast computed tomography, the lesion appeared as a well-defined hypodense mass like an abscess, while linear mottled enhancement was observed on the postcontrast scan. Angiography revealed displacement of the hepatic arteries and portal veins, irregular neovascularity in the peripheral portion, and scant tumor stain without dilatation of the feeding artery. Review of the literature revealed only 10 previous reports.

Immunohistochemical localization of glycosaminoglycans and proteoglycans in predentin and dentin of rat incisors

We examined immunocytochemically the type and distribution of glycosaminoglycans and proteoglycans (PG) in predentin and dentin demineralized with EDTA after aldehyde fixation of rat incisors using (a) four monoclonal antibodies (1-B-5,9-A-2,3-B-3, and 5-D-4) which recognize epitopes in unsulfated chondroitin (C0-S), chondroitin 4-sulfate (C4-S), chondroitin 6-sulfate (C6-S), and keratan sulfate (KS) associated with the PG, and (b) monoclonal (5-D-5) and polyclonal antibodies specific for the core protein of large and small dermatan sulfate (DS) PG. Light microscope immunoperoxidase staining after pre-treatment of tissue sections with chondroitinase ABC localized the majority of stainable PG (C4-S, KS, DSPG, C0-S, and C6-S) in predentin and, to a lesser extent (C4-S and small DSPG), in the dentin matrix. The former site demonstrated relatively homogeneous PG distribution, whereas the latter site revealed that strong staining of C4-S and small DSPG was confined mostly to dentinal tubules surrounding odontoblastic processes, with only weak staining in the rest of the dentin matrix. These results indicate that there is not only a definite difference between PG of predentin and dentin but also a selective decrease in the concentration or alteration of these macromolecules during dentinogenesis and mineralization.

[Staged operation for supravalvular aortic stenosis syndrome associated with severe multiple peripheral pulmonary stenoses: a case report and surgical methods]

Successful surgical correction of supravalvular aortic stenosis (SAS) syndrome associated with severe peripheral pulmonary stenosis by a staged approach in a 6-year-old boy is reported. Right ventriculogram demonstrated bilateral severe peripheral pulmonary stenoses and cardiac catheterization revealed severe pressure gradient of 94 mmHg between the trunk of pulmonary artery and right and left peripheral pulmonary arteries, respectively. Bilateral severe peripheral pulmonary stenoses were relieved successfully by staged operations. Initially, a stenotic portion of the right pulmonary artery and its bifurcation was removed and a DeBakey Knitted Dacron graft was interposed between the right pulmonary artery and the peripheral pulmonary artery which was enlarged by arterioplasty. Nine days later, stenosis of the left peripheral pulmonary artery was relieved by arterioplasty using a Rygg patch. Finally, 8 months after the initial operation, the patient underwent definitive repair of SAS by extended aortoplasty. The postoperative course of the patient was uneventful. Our experience indicates that in the surgical treatment of the patient with SAS and associated severe multiple peripheral pulmonary stenoses, a staged approach, that is initial staged repair of the bilateral pulmonary stenoses by arterioplasty through thoracotomy followed by definitive intracardiac repair of SAS, is the procedure of choice.

[Surgical treatment of interrupted aortic arch in infants under three months of age]

From March, 1982, through March, 1988, 8 infants less than 3 months of age underwent surgical treatment of interrupted aortic arch. Five patients had IAA type A and 3 patients had type B. Seven patients with associated VSD underwent staged operations and 1 infant with aortopulmonary window underwent primary repair off cardiopulmonary bypass. Aortic arch reconstruction was by subclavian aortic anastomosis (6) or large tube graft (8 mm) interposition (2) combined with pulmonary artery banding (5). All seven patients with associated VSD survived the first-stage operation. One patient subsequently underwent pulmonary artery banding, two underwent patch aortoplasty and four patients underwent intracardiac repair and removal of a pulmonary artery band, with six survivors (86%). The operative death occurred in an infant in whom modified Damus-Kaye-Stansel operation was carried out for severe subaortic stenosis, which rerouting all left ventricular blood through VSD and the main pulmonary artery into the ascending aorta and reconstructing right ventricular-distal pulmonary artery connection by a valved external conduit. All six surviving patients are doing well at present (mean follow up of 3 years) without any significant pressure gradient between the ascending and thoracic aorta. Based on these data we conclude: (1) Aortic arch reconstruction and pulmonary artery banding can be reliably performed even in critically ill infants with IAA and isolated VSD. (2) The primary repair will provide better chance of survival in infants with IAA associated with significant LVOTO, truncus arteriosus or aortopulmonary window that do not readily lend themselves to pulmonary artery banding.

Cutaneous metastasis from hepatocellular carcinoma resembling granuloma teleangiectaticum

We reported a case of cutaneous metastasis originated from hepatocellular carcinoma, which appeared as a nodule resembling granuloma teleangiectaticum. The nodule, which was composed of tumor cells and intervening capillaries, showed characteristics similar to those of primary hepatocellular carcinoma. On immunohistochemical staining, the tumor cells were positive not only for AFP (alpha-fetoprotein), but also for CEA (carcinoembryonic antigen), which is negative in most cases of primary hepatocellular carcinoma. We discussed this case with a review of previous reports of skin metastasis from liver carcinoma.

Differential distribution and ultrastructural staining of oxytalan and elastic fibers in the periodontal ligament of Alligator mississippiensis

We have investigated ultrastructural cytochemical properties of elastic elements in Alligator periodontal ligaments decalcified with EDTA and stained with 1) the tannic acid-uranyl acetate (TA-UA) method for elastin in combination with elastase digestion; 2) the high iron diamine-thiocarbohydrazide-silver proteinate (HID-TCH-SP) method with prior treatment of specimens with either monopersulphate or cupric-sulphite reagent for the localization of disulphide- and/or sulphydryl-containing material (i.e., oxytalan fibers); and 3) HID-TCH-SP alone for sulphated complex carbohydrates. Many microfibrils accumulated to form either large or small bundles. Large bundles having a diameter of 2.50 +/- 1.10 microns (mean +/- SD; n = 50) each showed an apico-occlusal distribution, although small bundles measuring 0.63 +/- 0.13 microns (mean +/- SD; n = 50) in diameter each were exclusively localized in interstitial areas rich in vessels and nerves. The former bundles always lacked TA-UA reactivity and represented oxytalan fibers; the latter bundles frequently contained TA-UA-reactive elastase digestible components and were similar in appearance to immature elastic fibers or elaunin fibers. HID-TCH-SP after oxidation strongly stained both the oxytalan and elastic fiber microfibrils but stained the amorphous elastin very weakly or not all. In nonoxidized specimens, there was no definite HID-TCH-SP staining of microfibrils and the amorphous elastin, although adjacent matrix proteoglycans stained consistently. These results indicate that although there is a marked difference in the distribution and size of oxytalan and elastic fibers in Alligator periodontal ligaments, their associated microfibrils lack stainable sulphate groups but are enriched with disulphide and/or sulphydryl groups, as has been described in mammals.

[Surgical repair of scimitar syndrome by direct anastomosis between right pulmonary vein and left atrium]

A surgical case of 8-year-old boy with scimitar syndrome is presented. The patient was admitted to the hospital because of exertional dyspnea and underdevelopment. Cardiac catheterization revealed a large amount of left to right shunt and O2 step up at the level of the inferior vena cava below the diaphragm. Angiography showed that the pulmonary vein draining the right lower lobe pierced the diaphragm and emptied into IVC. At operation the right pleural cavity was entered and a large anomalous pulmonary vein trunk was found which headed downward and medially and eventually entered in the diaphragm. A direct anastomosis between the scimitar vein and left atrium was made. To avoid kinking or stenosis of this vein, the parenchyma of the right lung (S7) was divided to create a passway of the vein. Anastomosis was performed without excessive tension or kinking on it. We conclude that the method applied in this case might be a procedure of choice for the repair of scimitar syndrome especially when there is no associating atrial septal defect or scimitar vein drains into IVC at the level lower than hepatic vein.

[Evaluation of endoscopic local injection of hypertonic saline- epinephrine solution and surgical treatment on hemorrhagic gastroduodenal ulcer]

For the purpose of arresting hemorrhage from gastric and duodenal ulcer we developed a method of endoscopic local injection of hypertonic saline-epinephrine solution (HSE), consisting of 625mEq/L or 1,250mEq/L sodium chloride with 0.05mg/ml epinephrine. During the period between October 1978 and March 1988, a total 246 patients with peptic ulcers underwent treatment for hemostasis by this method. According to our criteria for the assessment of the hemostatic effect, 231(93.9%) of 246 cases achieved permanent hemostasis, 7(2.8%) achieved temporary hemostasis, and no effect was noted 8 cases (3.3%). From June 1975 to March 1988, a total 366 cases with gastric and duodenal ulcers were operated on at our hospital. By applying endoscopic local injection of HSE, the rate of emergency operation for patients with bleeding peptic ulcers was significantly reduced from 13.4%(22/164) to 1.5%(3/202). From these results, we consider that endoscopic local injection of HSE is valuable for hemorrhage from gastric and duodenal ulcer.

Ebstein's anomaly and partial atrioventricular canal associated with double orifice mitral valve

A case of Ebstein's anomaly and partial atrioventricular canal associated with double orifice mitral valve is reported. Patch closure of the primum defect, plication of the atrialized ventricle, and tricuspid valve replacement with a St. Jude Medical valve were carried out successfully, and the patient is doing well 2 years and 9 months after the operation. To our knowledge, this combination of congenital heart defects has not been reported in the literature.

Complementary DNA encoding core protein II of human mitochondrial cytochrome bc1 complex. Substantial diversity in deduced primary structure from its yeast counterpart

Core protein II of mitochondrial cytochrome bc1 complex is the second largest nuclear-encoded subunit that is essential for the assembly of the functional complex. We have isolated, for the first time, a cDNA clone for a mammalian core protein II. Immunoscreening of a lambda gt11 rat liver cDNA library resulted in isolation of a cDNA encoding a partial sequence of rat mitochondrial core protein II, and this cloned cDNA was used as a probe for colony hybridization to screen a human fibroblast cDNA library. By comparison with the known NH2-terminal amino acid sequence of bovine core protein II, the amino acid sequence deduced from a cloned human cDNA was predicted to be composed of the part for the NH2-terminal extension of 14 amino acid residues and that for the mature polypeptide of 439 residues. The presequence is typical of precursors to mitochondrial proteins in being composed of a combination neutral and basic residues. The deduced sequence shows rather low homology with that of the corresponding subunit of yeast cytochrome bc1 complex; this finding is in contrast with the relatively high homology observed for the sequences of the redox center-carrying subunits of the same complex. On Northern blot analysis of human fibroblast poly(A)+ RNA, the cDNA hybridized to two mRNAs, a major species of 1700 nucleotides and a minor one of 2000 nucleotides. Southern blot hybridization of genomic DNA suggested that the human genome contains one or two genes for core protein II.

[False aneurysm of the right pulmonary artery--a rare complication of aorto-pulmonary shunt in a patient with tricuspid atresia]

A 12-year-old girl with tricuspid atresia who underwent a side-to-end anastomosis between the ascending aorta and the right pulmonary artery at the age of two months, developed a false aneurysm of the right interlobar trunk artery. The diagnosis was established by angiography, computed tomography and bronchoscopy. Emergency surgical intervention was required because of impending aneurysmal rupture into the right interlobar bronchus. Creation of a left Blalock-Taussig shunt to tide over the anticipated postoperative hypoxemia and right middle and lower lobectomy were carried out successfully. The false aneurysm in this case occurred following an episode of a streptococcal infection and was probably mycotic in origin. But it is possible that the presence of aorto-pulmonary shunt itself might have affected as a predisposing factor for aneurysm formation in this case.

[Operative technique of systemic to pulmonary artery shunt and aortoplasty utilizing in aberrant subclavian artery]

This paper presents a review of our experience of 3 cases of systemic to pulmonary artery shunt operation and 2 cases of subclavian flap aortoplasty using aberrant subclavian artery. The aberrant subclavian arteries were divided to release the vascular rings and were used as shunt grafts or reversed subclavian flaps. In case of shunt operation, this graft would be superior to the EPTFE graft of modified Blalock-Taussig shunt, from the point of view of the grafts' growth ability. In case of aortoplasty, if arch hypoplasia exists, this flap can repair it beyond the coarctation segment. When the aberrant subclavian artery is dissected, it should be avoided to use the contralateral subclavian artery, as it may cause cerebral damage because of the impairment of bilateral vertebral arterial circulation.

Isolation of a single nuclear gene encoding human ubiquinone-binding protein in complex III of mitochondrial respiratory chain

We have isolated five genomic DNA clones which contain nucleotide sequences hybridizable to a cDNA for human ubiquinone-binding protein in Complex III (QP). Nucleotide sequence analysis revealed that two of them contained different types of pseudogenes suggesting molecular evolution of the gene, and that the other three clones contained the overlapping fragments from the same QP gene. The gene spans 4.5 to 5 kb in length. The sequences of exons in the gene were determined and found to be identical to the corresponding parts of the human QP cDNA. The exon-intron boundaries follow the GT/AG rule. Two CAAT boxes were found in the promoter region. It is concluded from these results that the isolated human QP gene is functional. Genomic Southern blot analysis showed that the gene is present in a single copy in the human genome.

Photooxidation of hypotaurine to taurine in the presence of flavins

Irradiation of organic sulfinates such as hypotaurine and cysteine sulfinic acid in the presence of catalytic amounts of flavins led to the oxidation of its sulfinic groups (-SO2H) to the corresponding sulfonates. The process of hypotaurine oxidation in the presence of riboflavin, followed by absorbance decrease at 220 nm and by ion-exchange chromatography, showed a pseudo-first-order kinetics at pH 6.0. The k value depended linearly on flavin concentrations. The reaction rate was higher at acidic pH. Although the reaction rate was not affected by the addition of superoxide dismutase or catalase, superoxide ions were supposed to be by-products of the reaction. The effectiveness of allyl alcohol as a scavenger pointed to a free-radical mechanism of the reaction. We propose a new reaction mechanism involving sulfinic radicals on this photochemical reaction.

Early and late results of surgical treatment of coarctation of the aorta in the first three months of life

Forty infants under 3 months of age underwent repair of coarctation of the aorta (CoA) during an 8-year period. Preoperatively, 55% of the patients received intensive circulatory and/or respiratory care, and surgical relief of CoA was effected within 24 hours of diagnosis. The last 38 patients were managed by simple repair of the CoA in patients with significant VSD (Group II), with the addition of pulmonary artery banding in patients with complex cardiac lesions with VSD, or patients with incremental risk factors in Group II. There were no intraoperative deaths, one (2.6%) postoperative, and four (11%) late deaths in the last 38 patients. Only one (2.9%) showed signs of recurrence in 34 patients followed for 10 to 104 (mean 46) months. Improvement in the survival rate in this study can be attributed to: (1) aggressive preoperative care, (2) early noninvasive diagnosis and operation, (3) refinement in the surgical technique, and (4) appropriate use of pulmonary artery banding.

[Successful simultaneous repair of tetralogy of Fallot and congenital tracheal stenosis in a 5-year old child]

Congenital cardiac anomaly combined with severe obstructive lesion of airway remains a surgical challenge. A case of 5-year old child with tetralogy of Fallot associated with congenital tracheal stenosis (cartilagenous ring) was reported. The patient had history of cyanosis and stridor since age 3 months and had been hospitalized repeatedly for recurrent respiratory distress. The diagnosis was first established and emergent Blalock-Taussig shunt was carried out during first admission at age 1 year and 7 months. On the fourth admission at age 5 year, a definitive surgical intervention was decided following re-evaluation of the patient by cardiac catheterization, bronchoscopy and bronchography. Trachea and heart were exposed through cervical collar and presternal skin incision and median sternotomy. Tracheal resection and end-to-end anastomosis combined with total correction of tetralogy of Fallot was carried out under cardiopulmonary bypass. Utmost care was paid to avoid contamination during the operation. He was extubated at 9th postoperative day and has been free from symptom 9 months after the operation.

Cloning and sequence analysis of a cDNA encoding the Rieske iron-sulfur protein of rat mitochondrial cytochrome bc1 complex

We have isolated a cDNA clone for the Rieske iron-sulfur protein of rat cytochrome bc1 complex, by screening a rat liver cDNA expression library using antiserum directed against the corresponding protein of bovine. The amino acid sequence deduced from the nucleotide sequence of the cDNA indicated that the mature polypeptide of the rat protein consists of 196 amino acid residues with a molecular weight of 21,465, and that it is formed as a precursor with an amino-terminal extension. Northern blot analysis indicated that rat liver possibly contains different sizes of mRNAs for the Rieske iron-sulfur protein, and Southern blot analysis demonstrated that rats and mice possess a single gene for this protein.