Isolation, characterization, and expression analysis of zebrafish large Mafs

Large Maf proteins, which are members of the basic leucine zipper (b-Zip) superfamily, are involved in the determination and control of cellular differentiation. The expression patterns of various vertebrate large Maf mRNAs were described previously. Here, we report the cloning of a novel zebrafish large Maf cDNA, SMaf1 (Somite Maf1), and other zebrafish large Mafs, the N-terminus domains of which possess transactivational activity. We also analyzed the expression patterns of SMaf1 and SMaf2 (Somite Maf2)/Krml2 as well as MafB/Val and c-Maf during zebrafish embryogenesis. In particular, the robust expression of the novel SMaf1 mRNA, which overlapped that of MyoD, in somitic cells during somitogenesis was noteworthy. In addition, the expression patterns of SMaf2 and MafB in the blood-forming regions, and those of c-Maf and MafB in the lens cells showed spatial redundancy, although the temporal appearance of these genes at these sites differed. These data indicate that SMafs may play important roles in somitogenesis, and that Maf proteins may have overlapping and yet specific functions as to the determination and differentiation of cell lineages.

Aortic arch repairs through three different approaches

OBJECTIVES

The outcome of aortic arch repairs by means of three different approaches between 1990 and January 2000 was reviewed.

METHODS

In total 39 patients aged 71.5+/-6.2 years were operated on. The three different surgical approaches depended on the anatomical positions of the aneurysms and on their proximal or distal extension; a median approach was employed in 23 patients, whereas a left postero-lateral approach was used in eight patients. More recently, in eight cases a left antero-lateral approach was applied. All patients underwent open aortic anastomosis without any clamp on or around the aortic arch. During the procedure, the brain was protected by a combination of profound hypothermic circulatory arrest and several techniques of retrograde cerebral perfusion.

RESULTS

Permanent cerebral dysfunction occurred in four patients: two in the median approach and two in the left postero-lateral approach. There were two hospital deaths (5.3%) and six late deaths, all of which belonged either to the median group or to the postero-lateral group. The antero-lateral approach did not produce any cerebral dysfunction, early death, or late death.

CONCLUSIONS

The outcome of aortic arch repairs using profound hypothermic circulatory arrest and variable techniques of retrograde cerebral perfusion, by means of three different approaches, was satisfactory. Of the three approaches, the antero-lateral approach can be employed easily, whether aneurysms extend proximally or distally.

A case of right-sided aortic arch with isolation of the left subclavian artery: CT findings

We report a case of right-sided aortic arch with isolation of the left subclavian artery diagnosed using computed tomography (CT). This was a rare type in which the left subclavian artery, originating from the pulmonary artery via the arterial duct, was isolated after closure of the ductus. Collateral circulation was considered to be obtained mainly from the left intercostal artery via the costocervical trunk through the supreme intercostal artery.

Coronary surgery through partial sternotomy in a patient with tracheostoma

We report successful coronary artery bypass grafting through a lower partial sternotomy for a patient with a tracheostoma. He required a tracheotomy for serious laryngeal edema which developed during anesthetic induction prior to elective conventional coronary surgery. A safe alternative approach, comprising a lower midline skin incision with a lower partial sternotomy distant from the stoma, facilitated coronary artery bypass grafting to the left and right coronary arteries after four weeks.

Repeated procedure after radical surgery for tetralogy of Fallot

BACKGROUND

Although the immediate results of radical operation for tetralogy of Fallot are excellent, long-term follow-up has shown that the number of repeated procedures has increased in many institutions. We describe patients who underwent a second or third procedure after radical operation for tetralogy of Fallot.

METHODS

Between April 1981 and August 1996, we operated on 44 patients for the second time and on 4 for the third time after radical operation for tetralogy of Fallot. Indications for a second and third procedure included right ventricular outflow tract obstruction in 38 patients, infective endocarditis in 4, and isolated residual ventricular septal defect in 3.

RESULTS

One patient died after concomitant replacement of the pulmonary and tricuspid valves. Three patients who underwent sternotomy more than twice (before the second or third operation) underwent accidental cardiovascular trauma during this procedure (30%). Moreover, when patients underwent more than two sternotomy procedures before the repeated operation for tetralogy of Fallot, the total bypass time, interval between cessation of the cardiopulmonary pump to completion of the operation, amount of blood transfusion, and length of intensive care unit stay were significantly higher compared with those who underwent less than two sternotomy procedures (p < 0.05). Right ventricular outflow tract obstruction was the main indication for a second operation. After the second operation for right ventricular outflow tract obstruction in 35 patients, the preoperative right ventricle to left ventricle pressure ratio decreased significantly (from 0.75 +/- 0.13 to 0.51 +/- 0.12; p < 0.0001). However, the right ventricle to left ventricle pressure ratio did not significantly decrease in patients who underwent a third procedure to treat right ventricular outflow tract obstruction.

CONCLUSIONS

The surgical results of a second procedure after radical operation for tetralogy of Fallot were acceptable. However, the risk of accidental cardiovascular trauma during dissection was high among patients who underwent sternotomy more than twice before repeat operation.

[Long-term results of right ventricular outflow reconstruction with valved conduit]

Twenty-nine patients who underwent right ventricular outflow tract reconstruction using a valved conduit 37 times and survived surgery, were reviewed in this study. Hancock, Ionescu-Shiley, Carpentier-Edwards and Polystan was used for RVOTR. Freedom from reoperation rates of Hancock, Ionescu-Shiley and Carpentier-Edwardsat at five and ten years after surgery were 100%, 85.7%, 89.2% and 75%, 28.6%, 89.2%, respectively. The freedom from reoperation rates of Hancock and Carpentier-Edwards were significantly higher than that of Ionescu-Shiley. In conclusion, the freedom from reoperation rate at ten years was high for both Hancock and Carpentier-Edwards.

Sequential activation of transcription factors in lens induction

Since the pioneering work of the early 1900s, the lens has been used as a model system for the study of tissue development in vertebrates. A number of embryological transplantation experiments designed to elucidate the role of tissue interactions in the formation of the lens have led to the proposal of a stepwise determination model. This model has recently been refined through the identification of certain transcription factor genes, which exhibit distinct expression patterns and functional properties in the lens cell lineage. Otx2, Pax6, and Lens1 are induced by the adjacent anterior neural plate and expressed in predifferentiated lens ectoderm. Contact between the optic vesicle and lens ectoderm promotes expression of mafs, Soxs, and Prox1, which are responsible for the initiation of lens differentiation programs including crystallin expression, cell elongation, and cell cycle arrest. Further analysis of the expression and functional characteristics of these transcription factors will allow greater detail when describing the orchestration of genetic programs, which control tissue development from induction to maturation.

Apoptosis, cell proliferation and expression of oncogenes in gastric carcinomas induced by preoperative administration of 5-fluorouracil

The purpose of this study was to examine the correlations among enhancement of apoptosis, cell proliferation and expression of oncogenes in gastric carcinomas induced by preoperative oral administration of 5-fluorouracil (5-FU). The occurrence of spontaneous apoptotic cell death in 42 patients with gastric carcinoma was analyzed in the biopsy specimens preoperatively. p53 status was examined by polymerase chain reaction-single strand confirmation polymorphism and sequencing. Fourteen patients received oral administration of 5-FU at 300 mg/body/day for 7 days preoperatively. For detection of apoptotic cells, apoptotic incidences (AIs) were examined by the terminal deoxynucleotidyl transferase-mediated deoxy-uridine triphosphate biotin nick end labeling method, on gastric carcinoma lesions based on the endoscopic findings before administration in the biopsy and resected tissues. Expressions of p53, Bcl-2, Bax gene and proliferating cell nuclear antigen (PCNA) were also examined by immunohistochemical staining. On preoperative biopsy, p53 point mutation was observed in 14 of the 42 tumors. The immunohistochemical staining status and point mutation of p53 gene (positive or negative) were identical in 32 of the 42 tumors (76.2%). The average AIs of the biopsy specimens were 1.58+/-1.26% on p53-negative staining (n=19) and 1.14+/-1.02% on p53-positive staining (n=23), a significant association was not recognized between p53 expression and AI. In the preoperative administration group, the PCNA labeling index was significantly higher in the biopsy specimens than in the resected tissues (43. 6+/-12.8% vs. 35.3+/-8.8%, p<0.01). In addition, postoperatively, the rate of AI was significantly more accelerated in p53-negative staining (n=6) than in p53-positive staining (n=8) (0.89+/-0. 65%right curved arrow 4.18+/-3.26%, p<0.05 vs. 1.20+/-0.60%right curved arrow 2.60+/-2.60%, NS). There was no significant correlation between AI and Bcl-2 or Bax staining. Immunohistochemical analysis of p53 and PCNA stainings in biopsy specimens appears to be a well-characterized indicator of sensitivity of chemotherapy in gastric carcinomas.

[Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction]

Forty-eight patients who underwent right ventricular outflow tract reconstruction with Monocusp Ventricular Outflow Patch (MVOP) fifty-five times and survived surgery, were reviewed in this study. Mean age at surgery was 6.4 years-old and mean follow-up interval was 75.2 months. There was no late death, however reoperation was performed 7 times. Freedom from reoperation rate was 97.2% and 80.7% after 5 and 10 years after surgery, respectively. The main cause for reoperation were right ventricular outflow obstruction RVOTO (5 cases). All of the RVOTO occurred at the distal end of the anastomosis. However, there was no RVOTO in patients who underwent RVOTR with MVOP during the past ten years. So, we considered the cause of RVOTO a technical problem. Pulmonary regurgitation was one to two degree early after surgery, and had worsened by almost two or three degrees more than 5 years after surgery. Moreover, five of six patients who underwent cardiac catheterization more than 10 years after surgery had three degrees of pulmonary regurgitation as well as a large CTR. In conclusion, according to long-term results, especially more than 10 years post operatively, pulmonary regurgitation was the most important problem.

A case of thymic cyst associated with thymoma and intracystic dissemination

We report a rare case of anterior mediastinal thymic cyst together with a thymoma and its intracystic dissemination. More attention should be given to intramural nodules, especially in patients with an anterior mediastinal thin wall cystic lesion.

The synthetic rate of dipeptide catalyzed by organic solvent-stable protease from Pseudomonas aeruginosa PST-01 in the presence of water-soluble organic solvents

The initial synthetic rates of peptide Cbz-Arg-Leu-NH(2) from Cbz-Arg and Leu-NH(2) using PST-01 protease in the presence and absence of organic solvents were investigated under various conditions. The synthetic rates of Cbz-Arg-Leu-NH(2) in the presence of 50% (v/v) methanol, 50% (v/v) N,N-dimethylformamide (DMF) and 60% (v/v) dimethyl sulfoxide (DMSO) were 1.6-, 2.4-, and 5.1-times higher than that in the absence of organic solvent, respectively. The PST-01 protease was not only stable in the presence of organic solvents but also exhibited high reaction rates in the presence of methanol, DMF, and DMSO. When the Cbz-Arg concentration was lower than 60mM or the Leu-NH(2) concentration was lower than 400mM, the initial rates increased lineally with increase in their concentrations. However, the rates did not increase when the Leu-NH(2) concentration was more than 500mM. The optimum temperature and pH of the reaction were 40 degrees C and 7.0, respectively.

[Surgical results of the Senning operation and arterial switch operation for complete transposition of the great arteries]

From March 1980 to August 1997, 42 patients with complete transposition of the great arteries (TGA) type I and II underwent arterial switch procedure (n = 20) or Senning (n = 22) procedure in our institution. In arterial switch procedure group, there were two operative death. No late death occurred, and one patient underwent reoperation and one underwent balloon pulmonary angioplasty for right sided obstruction. The freedom from the intervention rate for right sided obstruction was 83.0% at 5 years, subsequently. In Senning procedure group, operative death occurred in two patients with TGA type II, and one patient with TGA type II and two patients with type I died because of cardiac events in the late stage. In this group, two patients died from accident. The survival rate excluding accidental deaths was 77.7% and 77.7% at 5 and 10 years, respectively. However, those patients who died in the late stage had severe pre-operative and post-operative complication. In conclusion, mid-term results of arterial switch procedure is satisfactory, however, reintervention rate was not so low. Long term results of Senning procedure without preoperative or postoperative complication was satisfactory.

Toxicologic evaluation of yessotoxin

Yessotoxin (YTX), originally found in association with diarrhetic shellfish poisoning (DSP), caused neither intestinal fluid accumulation nor inhibition of protein phosphatase 2A. Orally, YTX was not lethal to mice at 1.0 mg/kg. The toxin showed weak cytotoxic and antifungal activities. Neither hemolytic nor ichthyotoxic effect was observed.

The Koga Hospital Center for studies on sleep: status report

Between September 1996 and January 1999 we used polysomnography (PSG) to examine 473 patients (involving a total of 662 records). The diagnosis was a sleep-related breathing disorder in 256 patients, including sleep apnea syndrome (SAS) in 194 patients, sleep hypoxicemia in 18 and insomnia in the other four. The SAS consisted of three subtypes: central apnea (CA) in 56 patients, obstructive apnea (OA) in 124 and mixed apnea (MA) in eight. The ratio of central apnea was relatively higher than the national average. Among the 473 patients, the most common complication was heart disease (133 patients) while other complications included hypertension, and respiratory and cerebrovascular diseases. Concerning the therapy for these patients, continuous positive airway pressure therapy was the most commonly applied and was effective in each type of SAS (CA, OA, MA). Other therapies included prosthetic mandibular advancement, bilevel positive airway pressure, medication and ENT operations. In Koga Hospital, there are many patients with heart disease and/or respiratory disease. We examined those patients who presented with snoring and/or apnea using PSG. Among these patients, SAS was the most common sleep disorder. The relative ratio of CA was high and the average age was higher than those with OA.

beta-blocker therapy in patients after aortic valve replacement for aortic regurgitation

BACKGROUND

beta-blocker therapy for dilated or ischemic cardiomyopathy is now an accepted and effective treatment. However, little is known about its efficacy in patients with postoperative impaired left ventricular function. This retrospective study was designed to assess the effects of beta-blocker therapy in patients after aortic valve replacement (AVR) for aortic regurgitation (AR).

METHODS

A total of 59 patients who underwent AVR for chronic AR were assigned to four groups. Twelve patients were treated with both ACE inhibitors and beta-blockers, 12 patients with only ACE inhibitors, eight patients with only beta-blockers, and 27 patients without beta-blockers or ACE inhibitors. A postoperative echocardiographic study was performed one year after surgery.

RESULTS

The heart rate was significantly reduced in patients with beta-blockers despite the use of ACE inhibitors after surgery. Postoperative left ventricular volume was more significantly decreased in beta patients than in non-beta patients despite the use of ACE inhibitors. There were also significant reductions in left ventricular mass index in ACE+beta patients compared to ACE+non-beta patients. However, there were no significant differences in NYHA functional class and survival rate between beta patients and non-beta patients.

CONCLUSIONS

beta-blocker therapy may improve cardiac performance by reducing cardiac volume and mass in patients with impaired LV function after AVR for AR.

Treatment for abdominal aortic graft infection: irrigation with electrolyzed strong aqueous acid, in-situ grafting, and omentoplasty

We report on successful surgical treatment of consecutive three patients with infection of an abdominal aortic graft, Therapy involved a combination of removal of the infected graft, elaborate debridement, irrigation with electrolyzed strongly acidic aqueous solution (ESAAS), in-situ regrafting, and omentoplasty. The use of ESAAS is discussed.

Purification and characterization of organic solvent-stable lipase from organic solvent-tolerant Pseudomonas aeruginosa LST-03

An organic solvent-stable lipase (LST-03 lipase) secreted into the culture broth of the organic solvent-tolerant Pseudomonas aeruginosa LST-03 was purified by ion-exchange and hydrophobic interaction chromatography in the presence of 2-propanol. The purified enzyme was homogeneous as determined by SDS-PAGE. The molecular mass of the lipase was estimated to be 27.1 kDa by SDS-PAGE and 36 kDa by gel filtration. The optimum pH and temperature were 6.0 and 37 degrees C. LST-03 lipase was stable at pH 5-8 and below 40 degrees C. Its hydrolytic activity was highest against tricaproin (C6), methyl octanoate (C8), and coconut oil respectively among the triacylglycerols, fatty acid methyl esters, and natural oils investigated. The enzyme cleaved not only the 1,3-positioned ester bonds, but also the 2-positioned ester bond of triolein. It exhibited high levels of activity in the presence of n-decane, n-octane, DMSO, and DMF as well as in the absence of an organic solvent. In addition, LST-03 lipase was stabler in the presence of n-decane, ethyleneglycol, DMSO, n-octane, n-heptane, isooctane, and cyclohexane than in the absence of an organic solvent.

[Development of DICOM image browser for Macintosh computer]

Although many medical image browsers are available today, most are extremely expensive. To solve this problem, we developed a Digital Imaging and Communications in Medicine (DICOM) image browser (Medical Image Browser) for Macintosh computers. A comparison between this software, Advantage Workstation, NIH Image, and Graphic Converter suggested that this software is useful for diagnosis on the Macintosh desktop. This software is available at wwwl.odn.ne.jp/cak42860.

Two different techniques of retrograde cerebral perfusion for thoracic aortic surgery through a left thoracotomy

The authors used profound hypothermic circulatory arrest and continuous retrograde cerebral perfusion for aortic surgery that involved the distal arch through a left thoracotomy. For the first seven patients, oxygenated blood from cardiopulmonary bypass was perfused retrogradely through a venous cannula positioned into the right atrium. In the last 11 cases, venous blood, provided by a perfusion from the lower body, was circulated passively in the brain with the descending aorta clamped. The period of profound hypothermic circulatory arrest was 34.6 +/- 11.1 min, and continuous retrograde cerebral perfusion was 31.3 +/- 11.1 min. Seventeen patients survived, but there was one early death. Two patients with a severely atherosclerotic aneurysm developed permanent neurological dysfunction. The combination of profound hypothermic circulatory arrest, continuous retrograde cerebral perfusion and open aortic anastomosis through a left thoracotomy protects the brain adequately, and facilitates evacuation of debris and air in the aortic arch. It produces satisfactory results for aortic surgery that involves the distal arch.

Oral administration of the dopamine prodrug docarpamine shortens need for drip infusion of dopamine in patients with low cardiac output syndrome after cardiac surgery

BACKGROUND

Docarpamine (DOC) is a dopamine prodrug which can be orally administered. It has been found that oral docarpamine transforms into dopamine in vivo, and increases cardiac output and renal blood flow as effectively as intravenous dopamine.

METHODS

We reviewed the records of 26 patients who had developed low cardiac output syndrome (LOS) after cardiac surgery and received docarpamine during the early postoperative course. Five patients discontinued docarpamine within 2 days due to arrhythmia. There were 3 hospital deaths. The remaining 18 patients were divided into two groups according to the timing of docarpamine administration. In group A docarpamine was administered during and after weaning from intravenous catecholamines, in group B only on demand after weaning from intravenous catecholamines.

RESULTS

There were 12 patients in group A and 6 in group B, and the severity of LOS was relatively milder in group B than in group A. Stable hemodynamics and sufficient daily urinary output were maintained by oral administration of DOC in both groups just as well as by drip infusion of catecholamines.

CONCLUSION

Sinse continuous drip infusion of catecholamine commonly slows recovery in LOS patients, it is considered that switching from drip infusion of catecholamines to oral DOC administration is safe and useful for earlier recovery in LOS patients after cardiac surgery.

Purulent pericarditis presenting as an extracardiac mass in a patient with untreated diabetes

A 50-year-old man with symptoms of bi-ventricular heart failure was transferred to our hospital with a diagnosis of extracardiac tumor. He had a 10 year history of untreated diabetes. Chest computed tomography (CT) revealed an extracardiac mass in the right atrio-ventricular groove. Cardiac catheterization revealed an elevated mean right atrial pressure of 18 mmHg, mean pulmonary wedge pressure of 16 mmHg, and the right ventricular pressure curve demonstrated typical dips and plateaus. At surgery, there was severe adhesion between the pericardium and epicardium, and the pericardium was severely thickened and contained turbid pus. In the left thoracic cavity, there was large amount of pleural effusion and pus. Therefore, the patient was diagnosed with purulent pericarditis caused by left empyema. The thickened pericardium at the anterior portion of the heart was resected, however resection of the remaining portion was abandoned because the adhesion was so tight. After surgery, the patient underwent irrigation of the heart and left thoracic cavity by 1% povidone iodine solution and 0.5 mg/ml of imipenem for 7 days. Bacteriologic culture of the pus from the pericardium revealed anaerobic gram negative bacteria. After 4 months of antibiotics infusion, his C reactive protein became negative and the patient was subsequently discharged from our hospital.

Combined cardiac surgery and total thyroidectomy: a case report

A 65-year-old woman with aortic stenosis, ischemic heart disease, and Graves' disease had complained of effort angina. She then suffered from liver dysfunction due to treatment with antithyroid drugs. One year after the start of radioiodine administration, she demonstrated unstable angina with palpitation and sweating. Laboratory studies revealed a recurrent hyperthyroid state, and a second coronary angiogram revealed progressive ischemic heart disease. Combined coronary artery bypass grafting, aortic valve replacement, and total thyroidectomy were performed. The postoperative course was uneventful without any problems associated with hyperthyroidism or hypothyroidism. Combined cardiac surgery and total thyroidectomy can be performed safely if the perioperative levels of thyroid hormone are maintained at euthyroid or hypothyroid levels.

5-Bromodeoxyuridine induces senescence-like phenomena in mammalian cells regardless of cell type or species

5-Bromodeoxyuridine was found to induce flat and enlarged cell shape, characteristics of senescent cells, and senescence-associated beta-galactosidase in mammalian cells regardless of cell type or species. In immortal human cells, fibronectin, collagenase I, and p21(wafl/sdi-1) mRNAs were immediately and very strongly induced, and the mortality marker mortalin changed to the mortal type from the immortal type. Human cell lines lacking functional p21(wafl/sdi-1), p16(ink4a), or p53 behaved similarly. The protein levels of p16(ink4a) and p53 did not change uniformly, while the level of p21(wafl/sdi-1) was increased by varying degrees in positive cell lines. Telomerase activity was suppressed in positive cell lines, but accelerated telomere shortening was not observed in tumor cell lines. These results suggest that 5-bromodeoxyuridine activates a common senescence pathway present in both mortal and immortal mammalian cells.

Introduction of chromosome 7 suppresses telomerase with shortening of telomeres in a human mesothelial cell line

Introduction of human chromosome 7 by microcell-mediated chromosome transfer induced senescence in a telomerase-positive human mesothelial cell line, MeT5A. In microcell hybrids which underwent senescence, telomerase activity was decreased before entering senescence and telomeric sequences were shortened as cell division proceeded. Concomitantly, expression of the gene encoding telomerase catalytic subunit was abolished, whereas the genes encoding the RNA component of telomerase and its associated protein TEP1 were not affected. In revertants which arose from such microcell hybrids, telomerase activity was restored and the telomeric sequences were elongated. In microcell hybrids which showed no growth arrest, telomerase activity was unaltered. These results suggest that a putative mortality gene on chromosome 7 negatively regulates the telomere maintenance mechanism in MeT5A.

Chronic aortic dissection (DeBakey type II) with infective thrombus in the false channel

A 68-year-old man with a DeBakey type II chronic aortic dissection developed bacteremia secondary to a urinary tract infection with the Serratia species. This resulted in an infected thrombus in the false channel and a subsequent rupture of the ascending aorta. An emergency resection of the ascending aorta and a Dacron graft interposition were performed. The patient suffered from severe neurological insufficiency and died of pneumonia 6 months postoperatively. The optimal operation time and surgical options of an infected aortic dissection should be determined.