Effects of aprotinin on prostaglandin metabolism and platelet function in open heart surgery

The effects of the protease inhibitor, aprotinin, on plasma prostaglandin levels and platelet function during and after cardiopulmonary bypass (CPB) were studied in a group of 23 patients which consisted of 11 untreated patients (control group) and 12 aprotinin-treated patients (aprotinin group). Thromboxane B2 (TXB2, a stable metabolite of thromboxane A2) and beta-thromboglobulin levels in the control group increased significantly during CPB compared with preoperative values. These increases were significantly suppressed in the aprotinin group. 6-Keto-PGF1 alpha (stable metabolite of prostacyclin) increased significantly during CPB in both groups, and there was no significant difference between the two groups. In the aprotinin group, the TXB2/6-Keto-PGF1 alpha ratio decreased significantly during CPB compared with the preoperative value, whereas no significant decrease was observed in the control group. Platelet counts decreased significantly during and after CPB in both groups. Platelet aggregability decreased significantly during CPB in the control group, whereas no significant decrease was found in the aprotinin group. In conclusion, aprotinin treatment improved prostaglandin metabolism and preserved platelet function during open heart surgery.

[Intratumoral injection of OK-432 in conjunction with fibrinogen greatly enhances antitumor effect on colorectal carcinomas]

We found that antitumor effect of OK-432, a lyophylized preparation of an attenuated strain of streptococcus pyogenes, on colorectal carcinoma was greatly augmented when it was injected intratumorally in conjunction with fibrinogen. Twenty cases of colorectal cancer received intratumoral injection of 5 KE of OK-432 mixed with 80mg of fibrinogen including factor-XIII and 1ml of aprotinin at the time of endoscopic examination. Changes in the shape of the tumors were observed endoscopically within a few days after injection, and in most cases, decrease in the height of tumor margin was noted. Histopathological findings on surgically resected specimens revealed that the fine meshwork of fibrin was formed at the injected site soon after the injection, and a marked infiltration of inflammatory cells including neutrophils, plasma cells, macrophages, eosinophils and lymphocytes. Such granulomatous changes developed over 7 days after injection, and the degradation of tumors were observed. By 14 days after the injection, tumor tissues were largely replaced with granulomas, and shrinkage of tissues were observed. These findings indicated that fibrinogen including factor-XIII and aprotinin has a potential ability to augment the immunoreaction induced by biological response modifiers, and intratumoral injection of OK-432 in conjunction with fibrinogen solution was superior to intratumoral injection of OK-432 alone as the local immunotherapy of colorectal cancer.

[A study for non-asbestos casting liners. An experimental study of the adaptability of MOD casting to die]

Asbestos liners for investment metal casting has frequently been used in dental laboratory work. In recent years, the dangerous properties of asbestos to the human body were reported in Europe and the United States, and casting liners without asbestos were developed and marketed by many manufacturers. These are so-called non-asbestos liners. This study evaluated the adaptability of MOD inlay castings to dies using 8 kinds of commercial non-asbestos liners of ADA standard No. 2 specifications. The results were as follows; Single and double layers of Casting ribbon, New Asbestos Ribon, Shofu experimental, and KAOLIN showed good adaptation. Shofu experimental with a single layer showed the best marginal adaptation (10 microns). OVAL LINERS and CASTING LINERS with single layer showed good adaptation, but with double layers the adaptation was poor. In FLASK LINER, the double layer showed better adaptation than that with a single layer. Most non-asbestos liners used in this study are adequate in useful to MOD inlay castings.

Pharmacological properties of YM264, a potent and orally active antagonist of platelet-activating factor

The anti-platelet-activating factor effect of YM264 was examined in a variety of in vitro and in vivo test systems. YM264 inhibited [3H] platelet-activating factor binding to rabbit platelet membranes with a pKi value of 8.85. YM264 inhibited the platelet-activating factor-induced human, rabbit and guinea-pig platelet aggregation with pA2 values of 8.68, 8.33 and 8.14, respectively. However, at 10(-4) M the compound did not affect rabbit and human platelet aggregation induced by ADP, collagen arachidonic acid and epinephrine. YM264 reversed a platelet-activating factor-induced hypotension is anesthetized rats with an ED50 value of 0.005 mg/kg, i.v. Administered orally, YM264 inhibited platelet-activating factor-induced death in mice, hemoconcentration in rats and increase in vascular permeability in guinea-pigs with ED50 values of 0.19, 0.30 and 0.49 mg/kg, p.o., respectively. YM264, at 1 and 3 mg/kg, p.o., showed a significant anti-platelet-activating factor effect in a rat hemoconcentration model up to 6 hr after treatment. Moreover, in ex vivo experiments in guinea-pigs, YM264, at the doses of 0.3 to 3 mg/kg, p.o., shifted the dose-response curves of platelet-activating factor-induced platelet aggregation to the right in a parallel manner. These results indicate that YM264 is a selective, potent and orally active platelet-activating factor antagonist.

[Two cases of supposed metastasizing leiomyosarcoma of the uterus]

Case 1. A 57-year-old female had hysterectomy 10 years ago because of leiomyoma uteri. She was recently found to have a clear-cut round mass shadow in the right middle lung field on her chest X-ray film 3. The mass was resected and microscopically diagnosed as metastatic leiomyosarcoma. Re-examination of the pathological specimen of the uterine tumor resected 10 years ago revealed 5-9 mitosis per 10 high-powered fields (/10 HPF). Case 2. A 54-year-old female who had undergone hysterectomy for myoma uteri 9 years previously was found to have a well-defined oval shadow in the left lower lung field which was resected and pathologically diagnosed as metastatic leiomyosarcoma. Her uterus lesion microscopically revealed 1-2 mitosis/10 HPF. The relationship between metastatic leiomyosarcoma of the lung and mitotic activity of leiomyoma uteri was discussed.

Organization of variable region segments of the human immunoglobulin heavy chain: duplication of the D5 cluster within the locus and interchromosomal translocation of variable region segments

We have studied the organization of variable region (V) genes of the human immunoglobulin heavy chain (H) by cosmid cloning. We isolated two independent immunoglobulin D5 clusters (D5-a and D5-b) from cosmid libraries of the human genome. Restriction maps of these two regions showed that downstream 15 kb portions of the 55 kb overlap were different although upstream 40 kb portions were almost identical. Four more D segments, (DM, DXP, DA and DK) were found around the D5 segment in the conserved region of each cluster. Nucleotide sequences of the corresponding D segments from each cluster were almost identical and they encoded potentially functional D regions. Analysis using human-rodent somatic cell hybrids demonstrated that both clusters were located in the immunoglobulin heavy chain (H) locus on chromosome 14, suggesting that the D5-a and D5-b regions evolved by internal duplication within this locus. We also isolated a 60 kb DNA region carrying four VH segments, designated as VH-F region, which was located on chromosome 16. Nucleotide sequences of the four VH segments were determined. Two of them encoded potentially functional VH segments, and the other two were pseudogenes. Some more VH segments were found to be located outside chromosome 14, by Southern blot hybridization of human-rodent hybrid cell DNAs. These results provide further evidence that the human VH locus has undergone recent reorganization.

[A case report of chest wall reconstruction utilizing microvascular surgery]

A 62-year-old man underwent left chest wall reconstruction after resection of the chest wall including 4-6th ribs for the metastatic tumor of squamous cell carcinoma of the left lung. The chest wall defect measuring 15 x 10 cm was reconstructed with double Marlex mesh in skeletal chest and covered with pedicled free mucocutaneous flap of tensor fasciae latae which was implanted by the vascular anastomoses to the thoracodorsal artery and vein using microvascular surgical technique. The flap was attached well and its blood supply was excellent on postoperative angiography.

[Implantation of a ringed intraluminal graft in ruptured type III dissecting aneurysm]

A 81-year-old man with a ruptured type III dissecting aneurysm was successfully treated by the sutureless technique using a ringed intraluminal graft. This method is very useful for such an acute dissection because of its easy and quick insertion.

[Significance of coronary artery bypass grafting to totally occluded left anterior descending coronary artery]

The comparative studies on operative and hemodynamic results following coronary artery bypass grafting (CABG) were performed in 15 patients with totally occluded left anterior descending coronary artery (TOLAD) and 24 with partially occluded LAD (POLAD). There were two operative deaths and one whose graft was obstructed in POLAD. Four patients were revealed to have transmural myocardial infarction (TMI) in the region other than anterior segment on the preoperative electrocardiogram. Following results were obtained in 13 TOLAD (Group I) and 19 POLAD (Group II) with two subgroups, a: without TMI and b: with anterior TMI, whose all bypass grafts were patent. Left ventricular ejection fraction, Mean Vcf and left ventricular anterior, apical segmental wall motion significantly increased postoperatively in all groups, whereas postero-inferior segmental wall motion did not increase in all groups. Cardiac index and PLVSP/LVESV significantly increased postoperatively in all groups, but did not in Group Ib. Angina disappeared postoperatively in 12 patients (92.3%) in group I and 16 (84.2%) in Group II. In both groups, NYHA classification was improved from class III or IV preoperatively to class I or II postoperatively. Postoperative 10 years actuarial survival rate was 90.7% in Group I and 90.8% in Group II. In conclusion, it was proved that CABG to TOLAD offered significant increase in left ventricular contractility, better quality of life and satisfactory long term survival rate almost same as CABG to POLAD.

Preservation of pancreatic beta cell function with pulsatile cardiopulmonary bypass

Pancreatic islet cell function and tissue metabolism were studied during and after cardiopulmonary bypass in 38 patients undergoing an open heart operation. Twenty patients were operated on with pulsatile cardiopulmonary bypass (group I) and 18, with nonpulsatile cardiopulmonary bypass (group II). Hyperglycemia was observed during and early after operation in both groups. In group I during cardiopulmonary bypass, the immunoreactive insulin and c-peptide levels and the insulin to glucagon molar ratio increased significantly compared with the preoperative values, but in group II, these variables did not alter significantly. An hour postoperatively, the immunoreactive insulin (71 +/- 34 muIU/mL) and c-peptide (8.3 +/- 3.0 ng/mL) levels and the insulin to glucagon molar ratio (11.0 +/- 5.2) in group I were significantly higher than those in group II (immunoreactive insulin, 29 +/- 20 muIU/mL; c-peptide, 4.8 +/- 1.8 ng/mL; insulin to glucagon molar ratio, 3.4 +/- 2.6). The blood lactate level in group I (41 +/- 22 mg/dL) was significantly lower than that in group II (78 +/- 30 mg/dL) an hour postoperatively. In conclusion, pulsatile cardiopulmonary bypass is quite effective in preserving pancreatic beta cell function and tissue metabolism during and early after open heart procedures.

[An autopsied case of double carcinomata consisting of hepatocellular and renal cell carcinoma associated with adrenocortical adenoma]

Reported is an autopsied case of a double carcinomata associated with an adrenocortical adenoma in a 68-year-old Japanese female. The hepatocellular carcinoma was classified as being type II, according to Edmondson's classification, and showed massive necrosis caused by TAE and metastases to both lungs the diaphragm, the portal veins, the hepatic veins, and the inferior vena cava. The renal cell carcinoma was latent and diagnosed as being a mixed-cell type, with clear and granular cells also present. Double carcinomata of hepatocellular and a renal cell carcinoma are extremely rate and such a combination occupies merely 0.27-1.04% of the total double carcinomata reported in the Japanese literature. The adrenocortical adenoma in the present case was considered to be a non-functioning adenoma, based on no specific clinical symptoms during the woman's hospitalization.

[A case report of aortic and mitral regurgitation combined with ankylosing spondylosis]

The purpose of this communication is to present a successful case of surgical treatment of aortic and mitral valve regurgitation associated with ankylosing spondylosis. A 48-year-old male was admitted with symptoms of palpitation and shortness of breath. His heart murmur had been pointed out for 4 months prior to this admission. His previous history did not show any evidence of rheumatic heart disease. Retrograde aortography showed moderate to severe aortic valvular regurgitation and echocardiography revealed mitral valve regurgitation with minor degree. At the same time he complained of rigidity of neck muscle as well as back pain for last 15 years. He underwent aortic valve replacement and mitral valve was left alone. His postoperative course was uneventful. In Japan, aortic valve regurgitation associated with ankylosing spondylosis has been reported to be very rare compared to the European or American people. Several important features in the diagnosis and operative treatment for this combination of diseases have been also discussed.

The influence of coronary artery bypass grafting to totally occluded coronary arteries on the left ventricular contractility

Sixteen patients underwent 16 coronary artery bypass grafts (CABG) to totally occluded coronary arteries (TOCA), including 12 left anterior descending coronary arteries (LAD) and 4 right coronary arteries (RCA). Of these 16 CABGs, 2 of the RCA grafts became obstructed postoperatively and the remaining 14 patients with patent grafts were divided into the two following groups: 8 with previous infarcts in the region perfused by the TOCA (Group I) and 6 with no previous infarcts (Group II). The left ventricular (LV) ejection fraction and the mean verocity of circumferential fiber shortening significantly increased postoperatively in both groups and the PLVSP/LVESV significantly increased postoperatively in Group II. The LV segmental wall motion (SWM) in the region of TOCA significantly increased postoperatively in both groups. In 5 of the Group I patients, whose anterior and apical SWM was less than the lowest value of the normal subjects, the anterior and apical SWM significantly increased postoperatively. We thus concluded that CABG to totally occluded LAD results in an excellent graft patency rate, a significant improvement of SWM in the region of the TOCA and global LV contractility, even in patients with severe segmental dysfunction due to previous infarcts.

Effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system following open heart surgery

The effects of pulsatile cardiopulmonary bypass on the renin-angiotensin-aldosterone system and tissue metabolism, especially those which occur soon after surgery, were studied in 26 patients who required total cardiopulmonary bypass for longer than 60 minutes. These patients comprised 11 who underwent open heart surgery utilizing nonpulsatile cardiopulmonary bypass (Group I) and 15 who underwent open heart surgery utilizing pulsatile cardiopulmonary bypass (Group II). Plasma angiotensin II and serum aldosterone levels were significantly increased one and 5 hours postoperatively in Group I when compared with the preoperative values, whereas no significant elevations were observed in Group II. Plasma angiotensin II and serum aldosterone levels one hour postoperatively in Group II were significantly lower than those in Group I. Lactate levels in the arterial blood were significantly elevated, one and 5 hours postoperatively in both Groups I and II. Moreover, no significant difference was observed in the lactate levels between Groups I and II, one hour postoperatively. In the nonpulsatile group (Group I), plasma angiotensin II levels one hour postoperatively were correlated significantly with the duration of total cardiopulmonary bypass. In conclusion, pulsatile cardiopulmonary bypass offers significant advantages in terms of lower plasma angiotensin II and serum aldosterone levels, when compared with nonpulsatile cardiopulmonary bypass soon after open heart surgery requiring total cardiopulmonary bypass for longer than 60 minutes, however, it does not offer a definite advantage for tissue metabolism.

Cardiac rhabdomyoma associated with tuberous sclerosis. An autopsy case of newborn infant died of cardiac failure

An autopsy case of cardiac rhabdomyoma associated with tuberous sclerosis in a 27-day-old infant is presented. He was born with severe cyanosis. Echocardiogram revealed the presence of multiple mass lesions, some of which protruded into the left ventricle at the level of subaortic valve. From the age of 4 days, cardiac arrhythmia developed and lasted until his death. The arrhythmia started as WPW syndrome and atrial extrasystoles and then additional paroxysmal supraventricular tachycardia, ventricular fibrillation, sinus arrest, and S-A block occurred. Computed tomographic scanning of the brain revealed the presence of symmetric high-density spots around the central part of lateral ventricle. Before his death paroxysmal supraventricular tachycardia occurred frequently which changed to ventricular fibrillation and he collapsed without urination and then died. Autopsy examination revealed the presence of generalized congestion, multiple nodules of cardiac rhabdomyoma, some of which causing subaortic stenosis, and tuberous sclerosis in the brain. From the clinical and autopsy findings, the direct cause of death was attributable to the cardiac rhabdomyoma.

[Rupture of false aneurysm of the femoral artery caused by blunt trauma]

The successful surgical repair of a ruptured false aneurysm of the left femoral artery in a 44-years-old male is presented. He was admitted to this hospital with the chief compliant of marked swelling accompanied with severe pain of the left thigh and the past history of a blunt trauma 7 years ago on the left groin? He had also severe anemia with hb 4.4 g/dl. An aneurysm measuring 15 by 8 cm was detected on the arteriogram. The aneurysm was treated by resection and implantation of Gore-Tex graft with good result. The pathological findings strikingly suggested that the false aneurysm was caused by the old blunt trauma. A false aneurysm of femoral artery caused by a blunt trauma is very rare and it's complications include acute arterial occlusion, subsequent ischemic change of lower limb and massive bleeding by the rupture. In conclusion, early diagnosis and surgical treatment are essential for a false aneurysm of femoral artery.

[Influence of aorto-coronary bypass surgery on left ventricular function and prognosis in patients with severe left coronary artery disease]

The effects of aorto-coronary bypass surgery on left ventricular (LV) function and prognosis were studied in 21 patients with severe left coronary artery disease consisted of 8 left main trunk (LMT) stenosis and 17 left main equivalent (LME) that is the combined disease of left anterior descending (LAD) and left circumflex coronary arteries proximal to the origin of their major branches. One of 21 cases had bypass grafts occluded on the postoperative angiogram. The other 20 cases consisted of 10 cases with previous transmural myocardial infarction (PTMI) and 10 without PTMI had all bypass grafts opened including 20 grafts to LAD. In 10 cases without PTMI, all of LV function parameters markedly improved postoperatively. In the other 10 cases with PTMI, LV ejection fraction significantly increased from 0.53 +/- 0.07 preoperatively to 0.67 +/- 0.04 postoperatively (p less than 0.005). PLVSP/LVESV also increased from 1.85 +/- 0.66 to 2.89 +/- 1.16 (p less than 0.05). In both groups, LV segmental wall motion (SWM) increased in the anterior and apical segment, whereas did not in the postero-inferior segment. In the case with occluded grafts LV function was deteriorated postoperatively. Even in the cases which anterior SWM showed less than 30% (the lowest value in the normal subjects), anterior and apical SWM significantly increased postoperatively in both groups. Angina disappeared postoperatively in all cases but one with PTMI. All cases showed NYHA class III to IV preoperatively, then class I to II postoperatively. Postoperative 8 years actuarial survival rate was 91.0%.

[The effects of aorto-coronary bypass grafting to totally occluded coronary arteries on left ventricular contractility]

The effects of aorto-coronary bypass grafting (ACBG) on totally occluded coronary arteries (TOCA), postocclusion vessels of which were demonstrated angiographically through collaterals and left ventricular contractility were studied in eleven patients consisted of nine with transmural myocardial infarction (TMMI) on ECG in the area perfused by TOCA and without TMMI. Of eleven ACBG consisting of eight left anterior descending coronary arteries (LAD) and three right coronary arteries (RCA), all eight grafts to LAD were patent, whereas two of three to RCA were obstructed on the postoperative angiogram. The following evaluations were undertaken in the cases with patent grafts. In seven cases with TMMI (six LAD, one RCA), left ventricular ejection fraction (EF) increased from 0.56 +/- 0.08 (Mean +/- SD) to 0.65 +/- 0.07 (p less than 0.01). PLVSP/LVESV slightly increased, but not significantly. Mean Vcf increased from 1.07 +/- 0.33 to 1.83 +/- 0.88 circ/sec (p less than 0.02). Left ventricular segmental wall motion also improved from 23.1 +/- 6.8 to 29.5 +/- 7.2% (p less than 0.01), markedly in the anterior and apical segment. In two cases without TMMI, all of EF, PLVSP/LVESV, Mean Vcf and segmental wall motion improved much more than the cases with TMMI. In conclusion, it was suggested that ACBG to TOCA, especially LAD visualized angiographically through collaterals resulted in the excellent graft patency rate and the significant improvement of left ventricular contractility, even in the cases with TMMI.

[Aortocoronary bypass graft in coronary arterial stenosis with aortitis syndrome]

A 50-year old female who had aortitis syndrome with unstable angina due to severe coronary arterial narrowings is described. On the preoperative coronary arteriogram, 95% occlusion of the left anterior descending coronary artery (segment 6) and the left circumflex artery (segment 11), so-called "skip lesion" of aortitis syndrome, were revealed. The distal circumflex artery was well visualized through collateral vessels of the posterior descending branch of the right coronary artery. Therefore single aortocoronary bypass graft to the left anterior descending branch was done with good success. Postoperatively the patient has been completely free from anginal chest pain. Narrowing of the coronary artery due to aortitis syndrome is considered uncommon. Stenotic lesions have been reported to be limited mostly to the ostia and proximal segments of the coronary arteries, connecting to the aortic wall. Moreover, so-called "skip lesion" of the coronary artery as seen in this case is thought to be very rare.