[Clinical study on transfer into lung tissue of cefminox]

Nineteen patients who underwent pulmonary resection due to lung diseases were administered with 2 g of cefminox (CMNX) by intravenous drip infusion just before surgery. CMNX levels in the serum and lung tissue were determined and pharmacokinetic parameters were derived. The obtained results are summarized as follows: 1. Pharmacokinetic parameter (K1/K2) derived from serum and lung tissue concentrations using deconvolution method was 0.46. 2. CMNX was useful for prophylaxis of postoperative infections with lung resection.

Left ventricular aneurysm, normal coronary arteries and embolization in a patient with systemic lupus erythematosus

We describe a 30-year-old woman with a normal appearing coronary artery associated with SLE who suffered myocardial infarction with left ventricular aneurysm and systemic embolization including cerebral infarctions and saddle embolism. The patient was surgically treated with good results. To our knowledge this is the first reported case of systemic embolism due to myocardial infarction occurring in SLE with a normal coronary artery.

[A clinical experience of continuous warm blood cardioplegia in two cases of repeat aortic valve surgery]

The continuous warm blood cardioplegia (CWBC) was used for myocardial protection during aortic cross clamping in two cases of repeat aortic valve operations with good results. Case 1: A 46-year-old man, who underwent an aortic valve replacement because of the rheumatic aortic regurgitation (AR) in 1978, have suffered from orthopnea due to para-prosthetic valvular regurgitation since 1983. He was revealed to have bi-ventricular hypertrophy with myocardial damage on ECG, EF 0.27 on UCG, PCWP 20 mmHg and severe AR on cardiac catheterization. Case 2: A 43-year-old man, who had an aortic valvuloplasty for the non-rheumatic incompetency in 1981, have had a recurrent regurgitation, resulting in left ventricular hypertrophy accompanied by chest pain. Both cases were reoperated upon, having aortic valve replacement with mechanical prosthetic valves through the re-median sternotomy, utilizing CWBC with good recovery. CWBC provides an ideal circumstances for myocardial oxygen utilization during aortic cross clamping and moreover a benefit that needs not the wide dissection of the heart in a redo case because it has no need of topical cooling and ventricular defibrillation following aortic declamping. In conclusion, CWBC is very useful in a repeat aortic valve surgery.

Influence of coronary artery disease and left ventricular dysfunction on postoperative mortality in vascular surgery

In an attempt to assess the influence of coronary artery disease and left ventricular dysfunction on postoperative mortality, 107 patients consisting of 32 AAA resections and 44 aortoiliac and 31 femoropopliteal reconstructions were reviewed. All patients had a preoperative coronary angiograms and underwent cardiac catheterization to prevent cardiac-related deaths. Severe coronary artery disease was angiographically demonstrated in 40.6% of AAA, 31.8% of AI and 3.2% of FP patients. Severe left ventricular dysfunction was found in 21.9% of AAA, 18.2% of AI and 6.5% of FP. Both of the early and 5 (45.5%) of the 11 late deaths were caused by cardiac events. The nine-year survival rate (53.3%) in the patients with a documented combination of coronary artery disease and left ventricular dysfunction was significantly lower than those in patients with normal disease, normal left ventricular function and either documented coronary artery disease or left ventricular dysfunction. It is suggested from this series that left ventricular dysfunction is one of the most important risk factors in patients who undergo AAA resection and AI reconstruction and that severe disease and postoperative mortality are possibly reduced by certain kinds of interventional coronary therapies.

Trigeminal neurinoma presenting with intratumoral hemorrhage: report of two cases

We report 2 cases of trigeminal neurinoma presenting with spontaneous intratumoral hemorrhage. There are only 2 similar cases reported in the literature. Presenting symptoms were headache, diplopia, disturbed consciousness and trigeminal disturbance with sudden onset. CT scan showed a typical fluid-fluid level within low-density mass in the cerebellopontine angle in one case. On MRI, one case showed a typical fluid-fluid level on T2-weighted image and another one had mixed signal intensities including hyper- and hypointensities on both T1- and T2-weighted images. Histologically, increased vascularity, consisting of dilated and thin-walled vessels presenting telangiectatic or cavernous angiomatous appearances were observed in the specimens in both cases. The size of these tumors was about 3 cm each in diameter. Risk factors for hemorrhage appear to be large tumor size and increased vascularity.

[Successfully treated intraoperative coronary artery spasm in a patient with type B dissecting aortic aneurysm: a case report]

A 65-year-old man with chronic type B dissecting aortic aneurysm, complicated by variant from of angina pectoris without any coronary artery obstructed disease on preoperative angiogram was operated upon through left posterolateral thoracotomy under the left heart bypass with Bio-pump system using preoperative Ca antagonists and intraoperative nitroglycerin infusion. Shortly before the end of operation the patient suddenly developed shock status definitely due to coronary artery spasm, associated with ST-elevation in II, III, aVF and bradycardia, then ventricular tachycardia, finally cardiac arrest. The patient was resuscitated by cardiac massage and administration of nifedipine and nitroglycerin. Such attacks repeated five times at ten or twenty minutes intervals. The coronary artery spasm could be successfully suppressed with the additive use of noradrenaline infusion. The patient had no attacks at all postoperatively and was discharged with good success. This case suggests that the prevention of intraoperative coronary artery spasm is essential, but if it occurs, additive use of noradrenaline infusion is effective for the cessation of coronary artery spasm.

[Coronary artery bypass grafting in patients with severe left ventricular dysfunction: internal mammary artery vs saphenous vein, evaluation immediately after surgery]

Comparative studies of the changes in left ventricular (LV) function immediately after aortocoronary bypass graftings (CABG) and early postoperative results were carried out in two groups of patients with severe LV dysfunction (ejection fraction less than 0.4), which consisted of 9 patients received internal mammary artery grafts (IMAG) to at least LAD and 14 with saphenous vein grafts (SVG) only. The utilization of IMAG was limited to the patients with stable preoperative hemodynamics, whereas SVGs were used even in the emergency CABG. Free flow of IMAG measured during operation was 55.7 +/- 25.5 ml/min, which was significantly lower than that (83.5 +/- 27.3) of SVG to LAD. Cardiac index, LV stroke volume index and LV stroke work index immediately after surgery were sufficiently maintained and recovered almost similarly in both groups. Postoperative peak CK-MB (19.7 +/- 10.4 IU/L) in IMAG group was significantly lower than that (23.9 +/- 10.7) in SVG group. There was no significant difference between the two groups in the incidences of postoperative IABP and noradrenaline dependence. There were two hospital deaths in SVG group, whereas no hospital death was experienced in IMAG group. These results indicate that an application of IMAG to LAD in the patients with severe LV dysfunction surely induces satisfactory recovery of hemodynamics immediately after CABG as well as SVG, provided that use of IMAG is limited to the patients with stable preoperative hemodynamics.

Enhancing effect of pokeweed mitogen on the proliferation and the cytotoxicity of lymphokine-activated killer cells

In order to obtain more potent lymphokine-activated killer (LAK) cells for use in adoptive immunotherapy, pokeweed mitogen (PWM) was added to the culture medium for the initial 24-48 h of culturing. The proliferation rate of PWM-stimulated LAK cells reached about 1000-fold after 3-week culture. This rate was nearly the same as that of LAK cells stimulated by 10 ng/ml of OKT3, the mouse anti-CD3 monoclonal antibody. However, the cytotoxicity of PWM-stimulated LAK cells was significantly more potent than that of OKT3-stimulated LAK cells. Phenotypic analysis revealed that PWM-stimulated LAK cells were CD3+CD56(+)-dominant while OKT3-stimulated LAK cells were CD3+CD56(-)-dominant. About half of CD3+CD56+ PWM-stimulated LAK cells was CD8+. These results suggest that more efficient adoptive immunotherapy is possible by using high-dose PWM-stimulated LAK cells with more potent cytotoxicity. Interleukin-1 beta and tumor necrosis factor alpha were significantly increased in the culture media after 24-h incubation with 1 micrograms/ml of PWM. Secretion of interferon-gamma was not enhanced by this concentration of PWM within 24 h. Therefore, PWM is considered to activate monocytes or macrophages to produce these cytokines in advance, influencing the proliferation and the cytotoxicity of LAK cells.

[A resected case of thymolipoma]

We reported a resected case of thymolipoma, which has been hardly experienced. The patient was 21-year-old female and consulted a doctor for general fatigue. Chest roentgenogram revealed a mass-like shadow at the right lower mediastinum, which was suspected mediastinal tumor. The mass of right anteroinferior mediastinum, which was clearly shown by chest CT scan and MRI, was continued to the right lobe of the thymus. Under a diagnosis of anterior mediastinal tumor, operation was carried out. The tumor, which was 10 x 8 x 7 cm in diameter and 160 g in weight, was removed together with right lobe of the thymus. Histological diagnosis of thymolipoma was obtained from the resected specimen.

[Imprint cytodiagnosis of lymph node metastasis in resected lung cancer]

The cytological examination of lymph node imprints is a rapid and useful method for diagnosis of lymph node metastasis. We applied this technique for the diagnosis of regional lymph node metastasis of resected lung cancer, and compared its diagnostic value with histological examination. The accuracy rate of imprint cytology is 97.3%, and the sensitivity rate is 100%. We conclude that imprint cytology of lymph node for diagnosis of cancer metastasis is highly accurate and simple, and its diagnostic value may be equal to that of routine histological examination.

Electrophysiological properties of membrane currents in single myometrial cells isolated from pregnant rats

The whole-cell voltage-clamp method was applied to single smooth muscle cells prepared from the longitudinal layer of the pregnant rat myometrium (17-20 days of gestation). It was found that the transient inward current mainly consists of Ca2+ current, because the removal of Ca2+ ions from the external medium and 10 microM nifedipine eliminated this inward current. Its steady-state inactivation curve was obtained by the standard method, in which the membrane potential of half inactivation and the slope factor were estimated to be -58.0 +/- 4.9 mV (n = 11) and 8.9 +/- 1.4 mV (n = 11), respectively. In a small number of preparations (in 2 out of 30 preparations), there remained a very fast inward current in Ca(2+)-free medium containing Mg2+. Tetrodotoxin (TTX, 10 microM) can can abolish this current, suggesting that the channel for this current is equivalent to the Na+ channel in nerve cells. Two major phases of outward currents were identified by voltage jumps from negative holding levels to more positive levels. The first phase was a fast transient outward current. This current remained intact after external tetraethylammonium (TEA, 20 mM) was added. Following the transient current, a large delayed rectified outward current reached its peak over a period of 50 ms and then decayed. The reversal potential for this outward current was determined by observing the change of polarity of the tail currents with the change in extracellular K+ concentration [( K+]o). The slope for the change of reversal potential per ten-fold change in [K+]o is 57.7 mV at more than 23.2 mM [K+]o, indicating that this current is mostly carried by K+ ions. Voltage-dependent inactivation of the delayed rectified outward current was determined by the standard method. The membrane potential for half inactivation and the slope factor were estimated to be -42.8 +/- 3.9 mV (n = 3) and 10.1 +/- 1.5 mV (n = 3), respectively. External TEA (20 mM) effectively eliminated the delayed rectified outward currents. Nifedipine (10 microM) suppressed not only Ca2+ current but also outward K+ currents.

[Arachidonic acid metabolism and effectiveness of aprotinin treatment during cardiopulmonary bypass]

Arachidonic acid metabolism was investigated in 30 open heart cases, utilizing nonpulsatile cardiopulmonary bypass (CPB), consisted of 15 untreated cases (Group I) and 15 cases treated with aprotinin mostly given into CPB circuit during CPB (Group II). In group I, arterial blood concentration of thromboxane B2 (TXB2, stable metabolite of thromboxane A2, pg/ml) significantly increased from 45.9 +/- 40.5 preoperatively to 560.2 +/- 381.5 (p less than 0.01) at 30 minutes of CPB (total bypass) and to 830.5 +/- 591.1 (p less than 0.005) at the end of CPB (partial bypass). TXB2 levels in pulmonary artery (PA) and left atrium (LA) did not significantly increase just before, 5 minutes of CPB as compared with preoperative value. At the end of CPB TXB2 levels in PA (625.0 +/- 186.3) and LA (817.0 +/- 320.0) were significantly higher than preoperative value. However there was no significant difference between PA and LA values. Contrarily in group II TXB2 levels were significantly suppressed as compared with the value at each corresponding time in group I. beta-thromboglobulin levels also changed almost parallel to TXB2 levels in both groups. In conclusion, arachidonic acid metabolic disorders could occur in CPB circuit rather than in pulmonary circulation during CPB. Aprotinin administration into CPB circuit suppressed to some extent the platelet activation.

[Amplified DNA detection of HPV types 16 and 18 DNA in cervical scrapes by polymerase chain reaction]

Cervical scrapes from 43 patients (12 with chronic cervicitis, 13 with dysplasia, 11 with carcinoma in situ and 7 with invasive carcinoma) were examined by the polymerase chain reaction (PCR), to detect the amplified E7 gene of the HPV types 16 and 18 DNA sequence. HPV types 16 and/or 18 DNA were detected in 25 of 43 cases by the PCR (type 16 in 16, type 18 in 8, and both types 16 and 18 in 1). In comparison with the results for histological grades, the positive rate significantly increased as the grade of cervical dysplasia became higher. All cases were also examined with a HPV detection kit, the "Vira Pap" which contains 32P-labeled mixed RNA probes complimentary to HPV types 6, 11, 16, 18, 31, 33, 35 DNA. Six of 18 cases in which HPV DNA were not detected by the Vira Pap were positive for HPV types 16 and/or 18, so that the PCR was a highly sensitive method compared to the Vira Pap. The PCR has some advantages: 1. it requires only a small amount of specimens and 2. paraffin-embedded sections can also be used. We suggest that the PCR is a useful method for the screening and for retrospective investigation of HPV infection.

[Significance of radiotherapy in the multidisciplinary treatment of gynecological malignant tumor]

Effectiveness of radiotherapy and measures for improvement of treatment were examined with regard to cervical cancer, endometrial cancer and ovarian cancer, for (1) adenocarcinoma, (2) metastatic cancer, and (3) cancer in persons of advanced age. I. (1) The prognosis of cervical adenocarcinoma is poor, but radiotherapy in combination with chemotherapy can be expected to be effective for the poorly differentiated type, metastasis to the lymph node, and deep cervical invasion. (2) Radiotherapy has limited effectiveness for endometrial cancer and needs to be employed in combination with chemotherapy for the poorly differentiated type adenocarcinoma, serous adenocarcinoma, deep uterine wall invasion, vascular invasion, and metastasis to the lymph nodes. (3) In regard to cervical cancer and endometrial cancer, identification and computation of the labeling index of S-phase cells by BrdU and examination of the localization and the changes in the appearance of tumor markers and oncogenic products showed radiosensitivity of adenocarcinoma to be poor. (4) For ovarian cancer, whole pelvic irradiation by the moving strip (MS) method in combination with chemotherapy showed satisfactory results for stage I and stage II cancers. For stage III cancers, the results was not satisfactory when the residual tumor was 2 cm or larger in size. Whole pelvic irradiation of 50-TDF or more is necessary in such cases. II. The prognosis in cases of metastasis to multiple pelvic lymph nodes is poor. For such cases, it is desirable to employ paraaortic irradiation in combination with chemotherapy, with consideration of the histologic type and progress of the cancer. III. The prognosis is poor in persons of advanced age of 70 or over.(ABSTRACT TRUNCATED AT 250 WORDS)

[In situ hybridization study on the detection of HPV DNA in adenocarcinoma and adenosquamous carcinoma of the uterine cervix]

Human papillomavirus (HPV) types 16 and 18 have been found closely associated with squamous cell carcinoma and related lesions of the uterine cervix. In order to investigate the relationship between HPV and adenocarcinoma and adenosquamous carcinoma of the uterine cervix, formalin-fixed, paraffinembedded tissues prepared from 38 cases consisting of 30 cases of adenocarcinoma and 8 cases of adenosquamous carcinoma were examined for the presence of HPV DNA by in situ hybridization with digoxigenin labeled HPV 6/11, 16, 18 DNA probes. HPV DNA was localized on the nuclei of the cancer cells in adenocarcinoma and adenosquamous carcinoma. HPV DNA was detected in 13 cases (43.3%) of adenocarcinoma and 4 cases (50.0%) of adenosquamous carcinoma, and HPV type 18 DNA was detected in 13 cases (34.2%) of adenocarcinoma and adenosquamous carcinoma. These findings suggest an association between HPV, especially HPV type 18, and adenocarcinoma and adenosquamous carcinoma of the uterine cervix.

[Acute occlusion of the iliac arteries due to blunt trauma]

Two cases of acute iliac occlusion due to blunt trauma are presented. The cause of injuries were a fall from bicycle in case 1 and a compression between an automobile and a wall in case 2. The end-to-end anastomosis was possible in case 2, but an interposition of an artificial prosthesis was necessary because of the length of damaged artery in case 1. Both cases were associated with the pelvic fracture, adding the perforation of small bowels and the bladder in case 2. Postoperative course was almost uneventful except fasciotomy was needed for the compartment syndrome of the right lower extremity in case 2.

Activating effect of light irradiation at various wavelength on the respiration in sperm of the echiuroid, Urechis unicinctus, in the presence of carbon monoxide

In sperm of the echiuroid, Urechis unicinctus, respiration in the presence of CO was reversibly augmented by light irradiation in an examined range of wavelengths between 350 and 650 nm. The respiratory rate of sperm in the presence of CO was enhanced by light irradiation in proportion to the light fluence rate. A sharp and large peak was obtained at the wavelength of 430 nm in the action spectrum of photo-activated respiration of sperm in the presence of CO. Broad and small peaks were also found at around 530 and 570 nm. This action spectrum is similar in its profile to the absorption spectrum of reduced cytochrome b. Absorption of photon energy by reduced b-type cytochrome probably activates the redox reaction of this cytochrome to enhance the respiratory rate. Photo-activated respiration in the presence of CO was inhibited by antimycin A and cyanide. In this respiratory system, an electron equivalent is probably transferred through the mitochondrial respiratory chain between cytochrome b and cytochrome c and finally to molecular oxygen in the reaction catalyzed by the CO-insensitive terminal oxidase.

[Study on the localization of human papillomavirus DNA in the vulvar disease by means of in situ hybridization]

We investigated human papillomavirus (HPV) DNA of vulvar diseases obtained from 18 cases of condyloma acuminatum, 3 cases of hyperplastic dystrophy without atypia, 4 cases of lichen sclerosus, 4 cases of Bowenoid papulosis, one case of Bowen disease and 8 cases of squamous cell cancer by in situ hybridization with biotinylated HPV 6, 11, 16 and 18 DNA probes. The results of in situ hybridization analysis showed that HPV 6/11 was positive in 94.4% (17/18) of condyloma acuminatum. In 17 cases of HPV 6/11 positive condyloma acuminatum, 3 cases were positive for HPV 16 and one for HPV 18, respectively. HPV 16 was positive in 75.0% (3/4) of Bowenoid papulosis and one case of Bowen disease was positive for HPV 18. In two cases of Bowenoid papulosis which were positive for HPV 16, cervical carcinoma in situ containing HPV 16 DNA sequences was also found during the follow up period. In 8 cases of squamous cell cancer, 2 cases were positive for HPV 18, one for HPV 16 and one for HPV 6/11. All cases of hyperplastic dystrophy without atypia and lichen sclerosus were negative for HPV DNA. Our results suggested HPV is closely associated with vulvar neoplasia.

[Bronchopleural fistula after pulmonary resection of lung cancer]

From 1977 to 1988, 390 cases of lung cancer were resected in our hospital. In 12 patients (3.1%) a postoperative bronchopleural fistula developed. This complication occurred more commonly after right pulmonary resection than left and most common after right pneumonectomy. Moreover, that had occurred following right pneumonectomy was most fatal. After right middle and lower lobectomy, this complication occurred at the same rate as after pneumonectomy and also caused a fatal result. On the other hand, after the resection of single lobe, the rate of the occurrence of a bronchopleural fistula was lower. And, even if it had developed, the fistula sometimes could be healed by a conservative treatment only. In one of our cases the fistula was successfully treated by intra-bronchial gluing through a bronchofiberscope.

[A case of spontaneous esophageal rupture treated with esophagectomy]

Although the rupture of the esophagus is frequently a catastrophic event leading to lethal consequences, the mortality and morbidity rate can be significantly lessened by early diagnosis and nutritional management. Early recognition and intensive treatment of this condition are essential and life saving. Multiple techniques, often complex, are necessary to treat the disease, especially when the diagnosis is delayed. A 52-year-old women suffered from severe back pain after vomiting during breakfast, and was admitted to our hospital. Next morning bilateral massive pleural effusion was recognized, and chest drainage tubes were inserted into the bilateral pleural cavity. Three days after admission, drainage fluid changed to be mucous and dark green. Esophagography with Gastrografin demonstrated leakage from right wall of the lower esophagus. A right thoracotomy was performed 83 hours after the onset. In the lower esophagus, there was a longitudinal tear 3 cm in length and the mediastinum was significantly inflamed. So we decided to perform esophagectomy and esophagogastrostomy through ante-thoracic wall route. The right pleural cavity was debrided and thoroughly irrigated with saline. After chest drain removal, right hemothorax occurred in the postoperative period, but she had good recovery and was discharged from our hospital 2 months after the esophagectomy.

Increased spontaneous and mitomycin C-induced sister chromatid exchanges in patients with cancer of the cervix uteri, with special reference to stage of cancer

The frequencies of spontaneous and mitomycin C (MMC)-induced sister chromatid exchange (SCE) were examined in 35 patients with cancer of the cervix uteri (stage 0, eight cases; stage I, nine cases; stage II, nine cases, and stage III, nine cases) before they had undergone cancer treatment, as well as in seven patients with uterine myoma and 18 healthy women as controls. The frequency of SCE was analyzed in reference to the stage of cancer in the cancer group and in reference to chromosome group in the cancer and normal groups. The frequencies of spontaneous and MMC-induced SCE in the cancer group were 10.0 +/- 1.8 and 20.7 +/- 2.6, respectively, and both were significantly higher than in the myoma (8.1 +/- 0.8 and 17.6 +/- 1.8) and normal (7.6 +/- 0.8 and 17.6 +/- 2.3) groups. Furthermore, the frequency of SCE in the cancer group increased with cancer stage. All chromosome groups contributed equally to the increase in SCE in the cancer group. These results indicate that an increase in the frequency of SCE in patients with cervical cancer is related to the presence of cancer, but is not related to a predisposition to cancer.

[Clinical examination of resected cases of lung cancer with pleural dissemination]

Preoperative examination using chest computed tomography (CT) of cases with pleural dissemination and no pleural effusion revealed small disseminated nodules of the visceral pleura. However, chest CT could not exactly diagnose those of the parietal pleura. The indications of operation, especially pan-pleuropneumonectomy, for cases with pleural dissemination should be limited to the following cases; those in which no pleural effusion and no metastasis to the mediastinal lymphnodes has been clinically proved and in which it is not necessary to perform extensive combined resection other than pan-pleurectomy and partial resection of the diaphragm and/or pericardium. Well differentiated histological types of lung cancer are better indications for surgical treatment.