Effect of glutathione and its related enzymes on chemosensitivity of renal cell carcinoma and bladder carcinoma cell lines

Glutathione and glutathione-related enzymes have been implicated in sensitivity of tumors to chemotherapeutic drugs. In the present study, glutathione and the activity of its related enzymes were quantitated in 4 renal cell carcinoma cell lines and 4 bladder carcinoma cell lines. The expression of glutathione-s-transferase pi and alpha in each cell line was analyzed by immunoblot analysis. The relationships between glutathione levels, glutathione peroxidase activity and glutathione-s-transferase activity and tumor sensitivity to cisplatinum, doxorubicin and vinblastine were determined by linear regression analysis. Glutathione levels were positively related to cisplatinum resistance in both renal cell carcinoma and bladder carcinoma cell lines and to doxorubicin resistance in bladder carcinoma cell lines. A positive correlation between glutathione peroxidase activity and doxorubicin resistance was identified in renal cell carcinoma cell lines, but no correlation was noted in bladder carcinoma cell lines. No significant correlation was apparent between glutathione-s-transferase activity and sensitivity to any of the drugs tested in this study. To further clarify the relationship between glutathione levels and the cytotoxicity of the drugs, we evaluated the effect of glutathione depletion by L-buthionine sulfoximine on the cytotoxicity of the drugs in bladder carcinoma cell lines. Glutathione depletion enhanced cisplatinum cytotoxicity 1.3- to 1.7-fold and doxorubicin cytotoxicity by 1.45- to 11.2-fold. Glutathione depletion did not change vinblastine cytotoxicity. The present study demonstrates that glutathione and its related enzymes affect sensitivity to cisplatinum or doxorubicin. The drug resistance mechanism elicited by glutathione and its related enzymes in these tumors needs further elucidation so that chemotherapeutic regimens may be modified.

[Antigenic localities in the tissues of Metagonimus yokogawai observed by immunogoldlabeling method]

In order to determine the antigenic localization in the tissues of the adult Metagonimus yokogawai, immunogoldlabeling method was applied using serum immunoglobulins(IgG) of cats which were infected with isolated metacercariae from Plecoglossus altivelis. The sectioned worm tissue was embedded in Lowicryl HM 20 medium and stained with infected serum IgG and protein A gold complex(particle size: 12 nm). It was observed by electron microscopy at each tissue of the worm. The gold particles were observed on the tegumental syncytium as well as cytoplasm of tegumental cells and epithelial lamella of the caecum. The gold particles were not observed on the basal lamina of the tegument, interstitial matrix of the parenchyma, the muscle tissue and mitochondria of the tegument. The gold particles were specifically labeled in the secretory granules in the vitelline cells. They were also labeled on the lumen of bladder and egg shell. The above findings showed that antigenic materials in the tissue of adult worms were specifically concentrated on the tegumental syncytium as well as cytoplasm of tegumental cells and epithelial lamella of the caecum.

Thoracic aortic aneurysm associated with aortitis--case reports and histological review

Ten cases of post-inflammatory aneurysm of the thoracic aorta were studied morphologically using aortic wall and aortic valve tissue resected during the surgical repair of the lesions. Four cases of aortic aneurysm in Behcet's disease showed massive perivascular infiltration of the lymphocytes and plasma cells in adventitia and vasa vasorum. Fibrous obliteration of the vasa vasorum was seen, and neutrophilic infiltration was also associated in two cases with recurrent prosthetic valve failure. Three cases of aortic aneurysm associated with Takayasu's arteritis showed similar histologic features, but giant cells and histiocytic reactions were additional findings. Plasma cell infiltration was more pronounced compared to the Behcet's aortitis. One case of luetic aortitis showed a non-specific chronic inflammatory reaction with florid endothelial cell proliferation. One case of ankylosing spondylitis showed fibrous thickening at the periannular portion of the aortic valve cusps, but this finding was also seen in an aortic valve of a patient with Behcet's disease. One case without any disease association showed similar features of chronic inflammation with granuloma formation. The findings suggest that they have similar histologic features indistinguishable in terms of the clinical disease association, but a granulomatous reaction could be expected in Takayasu's arteritis.

A moving-actuator type electromechanical total artificial heart--Part II: Circular type and animal experiment

A new type of electromechanical total artificial heart (TAH) based on circular rolling-cylinder mechanism was developed to overcome critical problems in motor-driven artificial hearts such as large size and difficulties in fitting the heart to atrial remnants and arterial vessels. Its performance and reliability were evaluated in mock circulation and in an animal implant experiment. The total weight and volume of the pump is 650 g and 600 mL, respectively. This new pump was implanted in a calf for total heart replacement and 96 h of survival was achieved. The whole system, including pump, controller, and control algorithm performed well enough to improve the prospect of eventual clinical application of our TAH system.

A tether-free, moving actuator total artificial heart

An electromechanical moving-actuator TAH was developed and implanted for 5 days in a calf experiment. The efficiency and durability were further improved using pendulous motion of the actuator. This new pendulum pump has a circular motion produced by gear mechanisms connected to the motor. It has a height (from valves to housing bottom) of 7 cm and centrally directed inlets and outlets for good fittability. Active filling (-10 mmHg) inside inner blood sacs was produced by the suction effects of the outer sacs attached to a moving actuator. Two acute animal experiments were performed using the pendulum pump with a Coridale sheep (50 kg weight), and a male calf (70 kg weight). A test was made of 30 minutes of tether-free operation of the implanted pendulum pump inside the small chest of the calf. The pump shows the engineering feasibility of the implantable electrical TAH inside a human chest cavity.

Intraoperative assessment of blood flow and tissue viability in small-bowel ischemia by laser Doppler flowmetry

Laser Doppler flowmetry (LDF) was used for intraoperative assessment of blood flow and tissue viability in 23 patients with small-bowel ischemia, and the signal levels in ischemic bowel were compared with previously obtained reference values from normal ileum and jejunum. The average LD signal was 6.8 +/- 2.9 V in nonischemic bowel, 0.3 +/- 0.2 V in segments with macroscopically irreversible ischaemia and 2.1 +/- 1.2 V in segments with clinically uncertain viability. In 12 cases with strangulated bowel it was possible, following LDF, to avoid resecting nine of ten bowel segments with clinically uncertain viability. In four of the six patients with mesenteric vascular occlusion, LDF indicated that clinical judgement had underestimated the extent of severe ischemia. Among the five cases of iatrogenic ischemia there was one failure, with postoperative irreversible ischemia and anastomotic leakage. LDF is concluded to be a useful method for intraoperative assessment of intestinal blood flow in patients with small-bowel ischemia and it provides substantial information on tissue viability affecting surgical strategy.

Laser Doppler flowmetry in experimental mesenteric vascular occlusion

The performance of the laser Doppler-signal (measuring blood flow) and the direct current-signal (measuring the amount of backscattered light) were studied in isolated segments of feline small intestine during arterial or venous occlusion. Following total arterial or venous occlusion, the LD-signal rapidly fell to 16% and 29% of control values, respectively. The DC-signal decreased significantly (to 78% of control, p less than 0.001) in response to venous occlusion but did not change significantly following arterial occlusion. After total venous occlusion, the amount of backscattered light was sometimes insufficient to allow flow measurement, probably due to high light absorption in the congested tissue. After ligation of the vascular stalk, the LD-signal soon decreased to 10-15% of control but did not reach the baseline until 4-6 hours. It is suggested that this residual LD-signal is caused by activity in the muscularis layer in the early phase of intestinal infarction.

Demonstration of species-specific and cross reactive components of Paragonimus westermani crude worm antigen by EITB

Enzyme-linked immunoelectrotransfer blot (EITB) using crude worm antigen of adult Paragonimus westermani was performed for human patients sera to identify the species-specific components. Crude antigen was obtained by homogenizing and centrifuging 24-week old adult worms at 10,000 rpm for 60 minutes in phosphate buffered saline (PBS, pH 7.2) containing phenyl methyl sulfonyl fluoride (PMSF). Gradient sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) was performed and blotted electrophoretically onto a sheet of nitrocellulose paper. The sheet was cut into strips and exposed to sera diluted 1: 200 with PBS. SDS-PAGE showed 26 protein bands ranging 229 to 10 kDa. Of them 229, 91, 60, 50, 35-31, 27, 25, 21, 17, 11 and 10 kDa components showed positive reaction with serum antibody of patients with P. westermani. Sera of patients infected with Clonorchis sinensis reacted with 35-31, 19, and 11 kDa bands. Human sera from cysticercosis and diphyllobothriasis cases showed non-specific cross reactions with 229, 35-31, 27, 25 and 17 kDa bands. Protein bands of 91, 60, 21 and 10 kDa showed strong positive reaction without cross reactions with sera from other helminthic infections.

Intra-aortic balloon counterpulsation with special reference to determinants of survival

From 1981 through 1985 intra-aortic balloon counterpulsation (IABP) was required by 90 patients on a total of 91 occasions. They included 85 (3.1%) of the 2751 patients undergoing open-heart surgery during that time. IABP was used preoperatively in 13 cases, to assist weaning from cardiopulmonary bypass in 64, postoperatively in nine, and without cardiac surgery in five cases. Complications arose from IABP in 24/90 patients (27%). The overall short-term survival rate following IABP was 61%, and the long-term (mean 23 months) rate was 51%. Early recovery of cardiac function was the main determinant of survival. Female sex, renal failure and postinfarction ventricular septal defect and mitral incompetence were over-represented among the nonsurvivors. IABP therefore is useful in reversible left ventricular dysfunction, whereas inadequate perfusion of vital organs with potential for failure of more than one organ system implies diminished likelihood of survival.

Effect of continuous postoperative epidural analgesia on intestinal motility

The effect of postoperative epidural bupivacaine on intestinal motility was studied by measuring the transit time of barium contrast through the intestines in 16 patients after resection of the left colon and/or rectum. Fourteen patients served as controls and received postoperative injections of pentazocine. Mean transit time through the intestinal tract was 35 h in the epidural group and 150 h in the control group, a difference that is significant at the 0.1 per cent level. The average time before passage of flatus and faeces was different between the two groups at the 0.1 per cent level. We conclude that postoperative epidural bupivacaine constitutes an effective means of analgesia after colorectal surgery and is associated with a short duration of intestinal paralysis.

Assessment of gastric blood flow with laser Doppler flowmetry

The use of laser Doppler flowmetry (LDF) to measure gastric blood flow was evaluated in the cat and man. The reproducibility of laser Doppler flowmetry recordings was studied in the feline stomach. In five cats flowmeter signals and venous outflow of the stomach were simultaneously recorded. The flowmeter recordings were made during operation and gastroscopy in 140 patients by means of two different (PF1-4-kHz and PF2-12-kHz) laser Doppler systems. The flowmeter recordings were highly reproducible during the cat experiments, with a coefficient of variation varying between 4% and 13%. Angulation of the probe within 60-120 degrees against the tissue under study did not affect the flowmeter signal. Pressure of the probe against the studied tissue attenuated the flowmeter signal 42 +/- 13% (n = 10). A significant correlation coefficient (r = 0.76; p = 0.01; n = 30) was obtained between flowmeter signal and venous outflow of the stomach. In man the PF2-12-kHz system yielded a higher flowmeter signal (14.5 +/- 6.9 V; 32 patients) than the PF1-4-kHz system (7.9 +/- 2.5 V; 108 patients). Flow dimensions were calculated by using results previously obtained in the intestines. The estimated blood flow values amounted to 31 +/- 10 and 57 +/- 27 ml min-1 100 g-1 for the PF1-4-kHz and PF2-12-kHz systems, respectively. In conclusion, laser Doppler flowmeter is a promising technique for studying gastric perfusion during operation and endoscopy. Motion artifacts are the major drawback of the present laser Doppler systems.

Assessment of gastrointestinal blood flow with laser Doppler flowmetry in patients with chronic radiation injury

Laser Doppler flowmetry was used for pre- and intraoperative assessment of gastrointestinal blood flow and vascular damage in eight patients with late radiation injury of the gastrointestinal tract. The flowmeter recordings were compared with reference values previously obtained in unaffected tissue from corresponding gastrointestinal sites. Marked reduction of blood flow was demonstrated in macroscopic areas of radiation injury in all eight patients. Five also showed varying degrees of disturbed blood flow in adjacent macroscopically normal bowel segments with histologically varying severity of radiation injury. In a ninth patient radiation injury was clinically suspected but could not be demonstrated with laser Doppler flowmetry or histologically. The extent of radiation injury often is underestimated from clinical signs, and laser Doppler flowmetry during surgical treatment of late radiation injury to the gastrointestinal tract provides substantial information concerning the extent of vascular damage.

Complications of intra-aortic balloon counterpulsation, with special reference to limb ischemia

During a 5-year period, intra-aortic balloon pumping (IABP) was performed on 90 patients (3.1% of those undergoing open-heart surgery), using a Percor catheter inserted with Seldinger technique. Overall prognosis was poor; only 46 of the 90 patients were alive at postoperative follow-up averaging 23 months. Limb ischemia arose in 20%, with incidence uninfluenced by catheter insertion technique (percutaneous v. 'open'). Surgical treatment was required for half of the ischemic limbs. Groin hematoma commonly followed percutaneous extraction of IABP catheter, whereas 'open' removal was always hemostatic, with potential for embolectomy. Percutaneous insertion of IABP catheter via the femoral artery is the method of choice in an emergency situation. 'Open' Seldinger technique is preferable in the operating room. For elective IABP catheter removal, the 'open', hemostatic technique is recommended. If limb-threatening ischemia develops, the catheter must be removed. If the patient is IABP-dependent, the contralateral femoral artery or the ascending aorta should be considered as an alternative catheter route.

Effect of epidural anaesthesia on intestinal blood flow

The effect of epidural bupivacaine (5 mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in 15 patients during operations including various types of large bowel resection. In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41 per cent. In the ileum an increase was found in eight out of eleven patients who could be studied, which was significant at the 5 per cent level. Bowel function was restored satisfactorily in all patients. It is concluded that epidural bupivacaine has a favourable effect on intestinal blood flow during colorectal surgery.

Tissue penetration and measuring depth of laser Doppler flowmetry in the gastrointestinal application

Tissue penetration of laser light and measuring depth (depth sensitivity) for laser Doppler flowmetry in the gastrointestinal application were studied in the feline and human bowel and stomach with a wall thickness of from 2.1 to 7.0 mm. Mucosal and serosal recordings from corresponding sites in the gastrointestinal tract were comparable and in the intestine correlated to total blood flow. Laser light was reflected by a mirror placed on the opposite side of the bowel wall, and hyperemic reactions were similarly recorded from both sides of the bowel with wall thickness up to 6 mm. Placing layers of unperfused feline small intestine (average thickness, 2.1 mm) between the probe and the perfused feline gastric wall attenuated the laser Doppler signal in an exponential manner. We conclude that with this instrument, the tissue penetration and measuring depth of laser Doppler flowmetry are at least 6 mm in the gastrointestinal application.

Assessment of small-bowel ischemia by laser Doppler flowmetry. Some case reports

Laser Doppler flowmetry was used for intraoperative assessment of intestinal blood flow in five patients with small-bowel ischemia. In two patients with mechanically caused ischemia, bowel resection could be limited or avoided after flowmeter recordings. In two patients with mesenteric vascular occlusion, the flowmeter recording confirmed the macroscopic impression of irreversible gangrene. In a third subject with mesenteric vascular occlusion the extent of severe ischemia was clinically underestimated compared with the results obtained with the laser Doppler flowmeter. We conclude that, with further experience and development, laser Doppler flowmetry has great potential as a useful method for objective intraoperative assessment of blood flow in patients with small-bowel ischemia of various origins.

Local blood flow changes in association with proximal gastric vagotomy

Local blood flow changes in association with proximal gastric vagotomy were studied with laser Doppler flowmetry in 10 patients. After the vagotomy a significant decrease in blood flow amounting to 57 +/- 21% (range, 18-87%; p less than 0.001) was observed within the dissected area along the lesser curvature. In three patients, the flowmeter recordings suggested localized areas with very poor perfusion. The blood flow was restored to preoperative control values within 3-4 weeks after the operation. It is suggested that the temporary poor blood perfusion along the lesser curvature may be an important factor in the genesis of postoperative ulcerations in the dissected area. We conclude that laser Doppler flowmetry seems to have great potential as a method to study localized blood flow changes in the stomach. Flowmeter recordings can be made both during operation and endoscopy.

Measurement of colonic blood flow with laser Doppler flowmetry

Colonic blood flow was measured with laser Doppler flowmetry during operation in 62 patients and during coloscopy in 15 patients. In 18 subjects mucosal and serosal laser Doppler signals were compared during 'resting' conditions, vascular occlusion, and reactive hyperemia. The mucosal (n = 36) and serosal (n = 36) flowmeter signals were of the same order of magnitude throughout the whole range of flowmeter signals (r = 0.96; p less than 0.001). In eight subjects total venous outflow from a colonic segment was measured simultaneously with flowmeter recordings from the serosal side. A correlation coefficient of 0.95 (n = 46; p less than 0.001) was obtained between total intestinal blood flow and serosal flowmeter signal during 'resting' and reduced blood flows. In this flow range a calibration curve was constructed for interpretation of the flowmeter signals in absolute flow units. The wall thickness of the bowel determined the quantitative relationship between flowmeter signal and total intestinal blood flow. It is concluded that laser Doppler flowmetry represents a potentially very interesting non-invasive, continuous method for the quantitative study of human intestinal blood flow.

Assessment of blood flow in the small intestine with laser Doppler flowmetry

Blood flow in the small intestine was assessed in 48 patients by laser Doppler flowmetry. Mucosal and serosal flowmeter signals were compared during 'resting' conditions, vascular occlusion, and reactive hyperemia. Serosal flowmeter recordings were compared with the total blood flow of a bowel segment as measured by venous collection. The magnitudes of the mucosal (n = 49) and serosal (n = 49) flowmeter signals were comparable throughout the whole range of flowmeter signals (r = 0.97; p less than 0.001). A correlation coefficient of 0.95 (n = 51; p less than 0.001) was obtained between serosal flowmeter signals and total blood flow during 'resting' and reduced blood flows. During vasodilatation after a vascular occlusion, blood flow was underestimated by the flowmeter. A calibration curve could be constructed for approximate interpretation of the flowmeter signals in absolute flow units. The present study underlines the potential of laser Doppler flowmetry in the assessment of blood flow in the human small intestine.