Limited Dissection of Abdominal Aortic Aneurysm in a Patient with Multiple Myeloma

Dissection limited to the abdominal aorta contributes 4% of all aortic dissections, and inflammatory injury of the aortic media is one of factors associated with dissection. In multiple myeloma, leukocytoclastic vasculitis of the skin has been known. We describe limited dissection of an abdominal aortic aneurysm with dense lymphocyte infiltration in a 62-year-old man with multiple myeloma. Although it is unclear whether the lymphocyte infiltration in the aortic wall, which was denser than that of atherosclerotic aneurysm, was associated with multiple myeloma, the excessive aortic wall inflammation may have somewhat influenced aneurysm formation or aortic dissection.

DNA strand breaks are not induced in human cells exposed to 2.1425 GHz band CW and W-CDMA modulated radiofrequency fields allocated to mobile radio base stations

We conducted a large-scale in vitro study focused on the effects of low level radiofrequency (RF) fields from mobile radio base stations employing the International Mobile Telecommunication 2000 (IMT-2000) cellular system in order to test the hypothesis that modulated RF fields may act as a DNA damaging agent. First, we evaluated the responses of human cells to microwave exposure at a specific absorption rate (SAR) of 80 mW/kg, which corresponds to the limit of the average whole body SAR for general public exposure defined as a basic restriction in the International Commission on Non-Ionizing Radiation Protection (ICNIRP) guidelines. Second, we investigated whether continuous wave (CW) and Wideband Code Division Multiple Access (W-CDMA) modulated signal RF fields at 2.1425 GHz induced different levels of DNA damage. Human glioblastoma A172 cells and normal human IMR-90 fibroblasts from fetal lungs were exposed to mobile communication frequency radiation to investigate whether such exposure produced DNA strand breaks in cell culture. A172 cells were exposed to W-CDMA radiation at SARs of 80, 250, and 800 mW/kg and CW radiation at 80 mW/kg for 2 and 24 h, while IMR-90 cells were exposed to both W-CDMA and CW radiations at a SAR of 80 mW/kg for the same time periods. Under the same RF field exposure conditions, no significant differences in the DNA strand breaks were observed between the test groups exposed to W-CDMA or CW radiation and the sham exposed negative controls, as evaluated immediately after the exposure periods by alkaline comet assays. Our results confirm that low level exposures do not act as a genotoxicant up to a SAR of 800 mW/kg.

Primary Peritonitis Associated with Streptococcal Toxic Shock-Like Syndrome: Report of a Case

Several reports over the past 15 years describe severe group A streptococcal infections causing septic shock, soft-tissue necrosis, and multiple organ failure; a phenomenon known as streptococcal toxic shock-like syndrome (TSLS). However, primary peritonitis associated with TSLS is rare. We report the case of a 40-year-old man admitted with pain in both thighs, hypotension, and severe abdominal pain. His daughter had been diagnosed with streptococcal pharyngitis 3 days earlier. We performed an emergency laparotomy for peritonitis, and culture of the ascites was positive for group A beta -hemolytic streptococcus (GAS). Further serotyping of the isolated GAS strain revealed the T-type 22 and the pyrogenic exotoxin gene, spe-C. The criteria for TSLS were clearly met, including the isolation of GAS from ascites, hypotension, liver failure, renal failure, coagulopathy, myositis, and a generalized erythematous macular rash with desquamation.

Nonviral gene gun mediated transfer into the beating heart

Several techniques for gene transfer into the heart have been developed, including direct injection of naked plasmid DNA into the myocardium and coronary infusion of various viral vectors. However, complications and side effects with those methods have been reported. In this study, to resolve these problems, the authors investigated the feasibility of nonviral gene transfer into the beating heart with the hand held gene gun. The genes pCAGGS/CTLA4-EGFP were coated around the surface of gold particles. Three sizes of gold particles (0.6, 1.0, and 1.6 microm in diameter) and three settings of helium gas pressure (200, 250, and 300 psi) were examined. Gene transfer into the rat beating heart was performed using the hand held gene gun. EGFP expressions were detected by fluorescence microscopy from day 1 to 3 weeks after bombardment. The most prominent expressions were detected with the combination of 1.0 microm gold particles and 300 psi helium gas pressure. In this study, the present authors showed that non-viral gene transfer into the beating heart was feasible with the hand held gene gun. This technique is effective for gene transfer into the heart and may be one of the most useful methods for gene therapy for many cardiovascular diseases in the future.

Experimental studies to estimate the intestinal viability in a rat strangulated ileus model using a dielectric parameter

This study aimed at establishment of adequate evaluation of intestinal viability before release of the strangulated intestine by measuring electrical properties. In rats a 20-cm segment of the distal ileum and mesentery was strangulated. The intestine was strangulated for 0, 2, 15, 45, 90, and 120 min. The conductance and capacitance obtained by impedance analyzer were used to calculate tan(delta)m in the strangulated intestine. ATP was measured as well. In another experiment, after various periods of strangulation, tan(delta)m was measured just before release of the strangulation. Rats were divided into Group A (survived for 7 days) and Group D (died within 7 days). There was a positive correlation between tan(delta)m and ATP levels (P < 0.01). And tan(delta)m was significantly greater in Group A than in Group D (P < 0.05). There were no deaths at a tan(delta)m value of 2.36 or more and no survivors at a tan(delta)m of less than 2.20 except for one rat. These results suggested that tan(delta)m may be a useful index of the viability of the strangulated intestine before reperfusion.

Experimental studies to estimate the intestinal viability in a rat strangulated ileus model using a dielectric parameter

This study aimed at establishment of adequate evaluation of intestinal viability before release of the strangulated intestine by measuring electrical properties. In rats a 20-cm segment of the distal ileum and mesentery was strangulated. The intestine was strangulated for 0, 2, 15, 45, 90, and 120 min. The conductance and capacitance obtained by impedance analyzer were used to calculate tan(delta)m in the strangulated intestine. ATP was measured as well. In another experiment, after various periods of strangulation, tan(delta)m was measured just before release of the strangulation. Rats were divided into Group A (survived for 7 days) and Group D (died within 7 days). There was a positive correlation between tan(delta)m and ATP levels (P < 0.01). And tan(delta)m was significantly greater in Group A than in Group D (P < 0.05). There were no deaths at a tan(delta)m value of 2.36 or more and no survivors at a tan(delta)m of less than 2.20 except for one rat. These results suggested that tan(delta)m may be a useful index of the viability of the strangulated intestine before reperfusion.

Simultaneous operations for combined thoracic and abdominal aortic aneurysms

PURPOSE

To assess whether simultaneous operations are appropriate for combined thoracic and abdominal aortic aneurysms.

METHOD

Simultaneous operations were performed for combined thoracic and abdominal aortic aneurysms in nine patients. The thoracic aortic aneurysm (TAA) was repaired first, followed by repair of the abdominal aortic aneurysm (AAA). Selective cerebral perfusion was used in eight patients, after the exception of one who underwent replacement of the ascending aorta under hypothermic circulatory arrest. The abdominal organs were perfused during distal anastomosis in surgery for Stanford type A aortic dissection or aortic arch aneurysm; via the femoral artery with an aortic balloon occlusion catheter in one patient, and via an occlusion catheter with a perfusion lumen in two patients.

RESULTS

All patients underwent planned simultaneous repair of the AAA. One of the patients who underwent simultaneous replacement of both the descending thoracic and abdominal aorta was left with paraplegia, and one patient died suddenly of massive hemoptysis and melena on the 29th postoperative day. Autopsy revealed that the bleeding had been caused by aorto-broncho-esophageal fistulae. The overall operative mortality was 11%.

CONCLUSIONS

Simultaneous repair of combined TAA and AAA can be safely performed; however, the risk of paraplegia should be considered, especially with simultaneous repair of concomitant aneurysms of the descending thoracic and abdominal aorta.

The intravenous xylitol tolerance test in non-lactating cattle

Xylitol is a five-carbon sugar alcohol that is often used for treatment of ketosis in dairy cattle in Japan. An intravenous xylitol tolerance test (IVXTT, 0.1 g/kg, bolus injection through the jugular vein) was performed in 4 non-lactating cows (n = 4) and the results were compared with those of an intravenous glucose tolerance test (IVGTT) performed under equivalent conditions. The serum xylitol concentration reached a peak value (41.4+/-9.0 mg/dl) at 5 min, and then rapidly decreased and almost disappeared within 2 h. The C0 for xylitol was 56.9+/-16.6 mg/dl and the t(1/2) was 8.5+/-0.9 min. The administration of xylitol appeared to cause similar secretion of insulin to that caused by glucose. There was also a reduction in the concentration of free fatty acids. It seems that xylitol has value for the treatment of ketosis. However, rapid administration of xylitol appeared to have an osmotic diuretic action and might be a cause of dehydration.

Simultaneous operations for abdominal aortic aneurysm and liver cancer complicated by severe ischemic heart disease: report of a case

We performed successful simultaneous operations for an abdominal aortic aneurysm (AAA) and liver cancer in a patient complicated by severe ischemic heart disease. A 59-year-old man with a history of liver dysfunction presented with acute epigastric pain. Abdominal computed tomography findings of ascites and a liver tumor indicated a diagnosis of ruptured hepatocellular carcinoma. He had a concomitant 65-mm AAA and a 48-mm right common iliac aneurysm. Elective surgery was scheduled because of his good general condition. Although triple-vessel disease was detected preoperatively, there were no graftable coronary arteries. The aneurysms were repaired first to utilize intra-aortic balloon pumping (IABP) during resection of the liver cancer, followed by left lateral segmentectomy. Perioperative hemodynamics were maintained by administering catecholamines and vasodilators, without the need for IABP. The patient was discharged on the 21st postoperative day without any complications, and no recurrence of liver cancer has been found in the 5 months since his operation.

Analysis of the T cell receptor V beta repertoire in 2,4,6-trinitrobenzenesulfonic acid induced colitis in mice

The aim of this study was to analyze which types of T cells are at work and the specific nature of their response, using a mouse 2,4,6-trinitrobenzenesulfonic acid (TNBS) induced colitis model. The response of T cells to TNBS was analyzed by anti-TNBS mixed-lymphocyte reaction. T cell clones were established by limiting dilution. Phenotypes and T cell receptor (TCR) V beta of T cells were analyzed by flow cytometry. Colitis was induced by administration of TNBS enemas, and lamina propria lymphocytes were isolated and analyzed. The proliferative responses to TNBS of spleen T cells were partially inhibited by the addition of antimouse CD4 or CD8 antibodies to the mixed-lymphocyte culture. Conversely, these were inhibited by the addition of both antibodies. Flow cytometric analysis showed that TCR V beta 14 T cells specifically increased in the CD8+ T cell population. We established CD8+ TCR V beta 14 T cell clones which were TNBS reactive and self-restricted. Investigation using lamina propria lymphocytes in TNBS-induced colitis revealed that the rate of CD8+ TCR V beta 14 T cells changed with histological inflammatory activity which also attained a peak on day 5 following enema administration. Both CD4+ and CD8+ T cell subsets responded to TNBS, and the rate of CD8+ TCR V beta 14 T cells changed with histological inflammatory activity in TNBS-induced colitis.

Preoperative construction of an extracranial arterial shunt for resection of an aortic arch aneurysm with occluded left carotid artery

A 68-year-old man with aortic arch aneurysm was referred to our department. Preoperative carotid echography and magnetic resonance angiography revealed occlusion of the left internal carotid artery. Single-photon emission computed tomography scanning indicated that cerebral blood flow was decreased and reactivity to acetazolamide was reduced in the left temporal lobe. A successful superficial temporal artery-middle cerebral artery anastomosis was first made by neurosurgeons. A postoperative single-photon emission computed tomography scan showed that cerebral blood flow and reactivity to acetazolamide were remarkably improved. Two months after the anastomosis, the aortic arch aneurysm was successfully repaired.

Specific CTL activity of CD8+ TCR Vbeta14+ T cell in mouse 2, 4, 6-trinitrobenzene sulfonic acid-induced colitis

We analyzed the functional role of CD8+ T-cell receptor (TCR) Vbeta14+ T cells, which increased specifically in the lamina propria in 2,4,6-trinitrobenzene sulfonic acid (TNBS) -induced colitis. Cytotoxic activity and cytokine production in CD8+ TCR Vbeta14+ T-cell clones were analyzed by 51Cr release assay and enzyme-linked immunosorbent assay, respectively. Cell transfer studies using these clones were performed. Established T-cell clones showed specific cytotoxic activity against TNBS-conjugated self spleen cells, and this cytotoxicity was completely inhibited by anti-TCR Vbeta14 monoclonal antibody. These clones produced interferon (IFN) - gamma in their culture supernatant, but neither interleukin (IL) - 2 nor IL-4. Histological findings of the colon in mice, which received clone transfer after enema with suboptimal doses of TNBS, showed massive colitis. Our results indicate that CD8+ TCR Vbeta14+ T cells had a cytotoxic T-lymphocyte function induced by Th-1 T-cell response and played a pathogenic role in the development of TNBS-induced colitis.

Experimental studies on morphological changes of microcirculation of DMN-induced liver cirrhosis after normothermic ischemia with charge-coupled device microscope

AIM

The purpose of the present experiment was to find indices for intraoperative ischemic-reperfusion injury in the cirrhotic liver.

METHODS

One percent dimethylnitrosamine (DMN) was administered intraperitoneally to liver cirrhosis (LC) groups of Wister rats on three consecutive days of each week for a period of four weeks. The rats were divided into a N60 group with 60 minute ischemia in normal livers, a LC60 group with 60 minute ischemia in cirrhotic livers, and a LC30 group with 30 minute ischemia in cirrhotic livers. Digital videotapes recorded with a pencil lens-probe charge-coupled device (CCD) microscope were analyzed with NIH Image software. In zone 3, the sinusoid diameter (SD) was measured and the volume fraction (Vv) of zone 3 was calculated in preischemia and after 10, 20, 30, and 60 min of reperfusion. At the same time, bile flow was measured.

RESULTS

The SD was significantly shorter in the cirrhotic liver groups than in the normal liver group at each point. The Vv after 60 min of reperfusion was significantly smaller in the LC60 group, with a survival rate of 0%, than in the LC30 group which had a survival rate of 67%. However, there was no significant difference in bile flow after 60 min of reperfusion in the LC30 and LC60 groups. Therefore, the Vv is suggested to be the better index for viability after ischemic-reperfusion.

CONCLUSION

SD and Vv indicate microcirculatory differences and indices in the normal and cirrhotic livers in preischemia during reperfusion.

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis

Abdominal aortic aneurysm with arteritis in ankylosing spondylitis is described. An abdominal aortic aneurysm, 48-mm in diameter, in a 68-year-old woman with HLA-B27-associated ankylosing spondylitis was successfully replaced with a tube graft. The suture lines of the aortic wall were reinforced with Teflon felt strips. Pathologic examination of the aneurysmal wall revealed hyalinization of the connective tissue, with numerous lymphocytic infiltrates, remarkable calcification, and no elastic fibers. The original structure of the arterial wall was not recognized. These findings are compatible with aortitis reported in ankylosing spondylitis.

Hepatocyte growth factor gene transfer into the liver via the portal vein using electroporation attenuates rat liver cirrhosis

Although a variety of gene transfer methods to the liver have been designed, there are some problems such as the transfection efficiency and safety. In the present study, we developed a modified method of gene transfer into the liver by infusion of plasmid DNA via the portal vein followed by electroporation. After green fluorescence protein gene transfer, transgene expressions were detected in 24 h, and then maximally at 3 days, and persisted for 3 weeks. Histological analysis revealed that very mild tissue damage was induced in the liver to which electroporation was applied. In the second study, human hepatocyte growth factor (HGF) was more detected in the liver injected with 500 microg of human HGF gene than 100 microg of human HGF gene. However, serum HGF did not increase with 100 or 500 microg of human HGF gene. Moreover, 500 microg of HGF gene transfer into the liver by using this method could achieve the long survival of all dimethylnitrosamine-treated rats and attenuate the fibrous regions in the liver. These results suggest that HGF gene transfer into the liver via the portal vein using electroporation might be one of the useful methods for the treatment of various liver diseases.

Aortic arch repair for Stanford type A aortic dissection with distal anastomosis to the proximal level of the distal aortic arch

BACKGROUND

In acute type A dissection, replacing the ascending aorta with the transverse aortic arch recently has been recommended for event-free long-term survival. Since 1994, we have performed our new transverse aortic arch replacement, in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery to reduce the risk by obtaining a good surgical view, resulting in good hemostasis. The "elephant trunk technique" was used in anticipation of a staged descending aortic operation for residual dissecting aorta. We analyzed the surgical survival of patients with Stanford type A aortic dissection undergoing our operative procedure using hypothermic selective antegrade cerebral perfusion.

METHODS

We performed our new technique in 27 patients (aged 61 +/- 11 years, 15 male and 12 female patients, 22 patients with acute type A dissection, and 5 patients with chronic dissection).

RESULTS

One in-hospital death (3.7% in total: 4.5% in acute dissection, 0% in chronic dissection) occurred in patients undergoing our new technique. Actuarial survival (including early death) was 91% at 5 years after the operation. One late death occurred as the result of a malignant tumor. Four patients underwent a staged reoperation for aneurysmal dilatation of the residual descending aorta or renal and splenic embolism as the result of thrombus from the false lumen 2 to 11 months (mean interval 6 months) after the initial operation. They have been doing well since the reoperation.

CONCLUSIONS

Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.

Graft-preserving treatment for vascular graft infected with Staphylococcus aureus with antibiotic-releasing porous apatite ceramic in the rabbit

OBJECTIVE

This study was undertaken to investigate whether infection of a vascular graft with Staphylococcus aureus can be treated in situ by applying antibiotic-loaded porous apatite ceramic, in a rabbit model.

METHODS

Teicoplanin (TEIC) was loaded onto a beta-tricalcium phosphate (TCP) block, a type of porous apatite ceramic. The activity of TEIC released from the antibiotic-loaded TCP block was examined in vivo. A vascular graft was patched onto the abdominal aorta in 24 rabbits, and S aureus was applied directly on it. Seven days postoperatively, each rabbit underwent repeat laparotomy, and retroperitoneal abscess around the prosthetic vascular patch was debrided. Animals were divided into four groups of 6 rabbits each. In group 1 only debridement was carried out. In groups 2 and 3, solution containing 40 or 60 mg of TEIC, respectively, was applied to the prosthetic vascular patch. In group 4, an antibiotic-loaded TCP block (63 +/- 6.6 mg of TEIC) was placed around the graft. Three weeks after the second operation, the graft, the tissue around it, and arterial blood were collected and cultured.

RESULTS

TEIC activity was maintained for 28 days in vivo. In group 1, bacterial cultures of the prosthetic vascular graft and the tissue around it were positive in 5 animals and negative in 1 animal (infection rate, 83%). In both groups 2 and 3, cultures were positive in 3 animals and negative in 3 animals (infection rate, 50%). In group 4, cultures were negative in all animals (infection rate, 0%). Blood cultures were negative in all animals. Infection rate in group 4 was significantly lower than that in group 1 (P =.03), and was also lower than that in groups 2 and 3, but the difference was not significant.

CONCLUSIONS

Use of slow-release antibiotic loaded onto a TCP block, along with debridement, may control infection in vascular grafts in situ, averting the necessity to remove the graft.

Proximal Left Subclavian Artery Aneurysm Presenting Hemoptysis, Hoarseness, and Diplopia: Repair through Partial Cardiopulmonary Bypass and Perfusion of the Left Common Carotid Artery

Isolated true aneurysm of the subclavian artery is rare and can rupture, thrombose, embolize, or cause symptoms by local compression. We describe a case of a 67-year-old man with proximal left subclavian artery aneurysm presenting with hemoptysis, hoarseness, and diplopia. These symptoms suggested that the aneurysm ruptured, that the left recurrent laryngeal nerve was compressed by it, and that its mural thrombus caused cerebral embolism. It was incidentally confirmed that the aneurysm grew at the rate of 1.31 cm/year, from 3.0 to 4.2 cm in diameter for 11 months, preciously measured in a computed tomography scan. The aneurysm was successfully repaired via partial cardiopulmonary bypass and separate perfusion of the left common carotid artery through cross-clamping the descending thoracic aorta and the aortic arch between the origins of the brachiocephalic artery and the left common carotid artery. Neither partial clamping of the aortic arch at the portion branching the left subclavian artery nor taping the aortic arch between the origins of the left common carotid artery and the left subclavian artery could be achieved.

Surgical treatment of thoracoabdominal aortic mural and floating thrombi extending to infrarenal aorta

The case of a 49-year-old man with thoracoabdominal aortic mural and floating thrombi extending to the infrarenal aorta and occlusion of the common iliac artery is described. He had no factors promoting thrombosis, with a history of thrombectomy of the femoral artery. The thoracoabdominal aortic thrombi were successfully removed with a Forgaty catheter through a thoracotomy under simple aortic clamping and subsequent femoro-femoral cardiopulmonary bypass. Intravascular ultrasound performed through the femoral artery after thrombectomy revealed that little mural thrombi remained and that the celiac, superior mesenteric, and bilateral renal arteries were all patent.