Relationship of the strain and the intraocular amount of herpes simplex virus types 1 and 2 in the induction of anterior-chamber-associated immune deviation

We investigated the induction of anterior-chamber-associated immune deviation (ACAID) by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Two strains of HSV-1 (VR-3 and F) and four strains of HSV-2 (UW-268, 186, SL, and MS) were inactivated with ultraviolet light, and the anterior chamber of BALB/c mice was inoculated with a viral strain. Immunization against delayed-type hypersensitivity (DTH) was done subcutaneously on day 7 after anterior chamber inoculation. On day 10 after DTH immunization, each virus was inoculated into the foot pad. DTH was evaluated by measuring the foot pad thickness at 24 h after the inoculation into the foot pad. DTH was suppressed by anterior chamber inoculation with more than 10(3) plaque-forming units (PFU) of the VR-3, UW-268, 186, and SL strains, and with 10(5) PFU of the F strain, but not by the MS strain. Until now, HSV-2 was believed not to induce ACAID, however, our results indicate that some HSV-2 strains induce ACAID.ACAID induction by HSV-1 and HSV-2 may depend on both the viral strain and the amount of ocular viral antigen.

Pulmonary epithelioid hemangioendothelioma: a case report

A 45-year-old woman whose x-ray film revealed multiple widespread bilateral small nodules was diagnosed as having pulmonary tuberculosis or metastatic pulmonary cancer. A conclusive histological diagnosis of pulmonary epithelioid hemangioendothelioma (PEH) was made following an open-lung biopsy. PEH is a progressive disease that probably originates from an endothelial cell. However, there is still no effective therapeutic modality for PEH. The postoperative course of our patient has been uneventful with no evidence of tumor growth for four and a half years after initial x-ray detection of the lesions.

Intratracheal stent intubation under extracorporeal lung assist

An artificial stent was intubated using extracorporeal lung assist (ECLA) in two patients with inoperable tracheal stenosis. In a patient with an endotracheal tumor, an airway obstruction due to a partial stent collapse was overcome by an immediate ECLA perfusion. In another patient with chronic inflammatory tracheal stenosis, a repetitive balloon dilation of the trachea could be safely performed utilizing ECLA perfusion. Preventive femoral cannulation, employing the assistance of an ECLA circuit, is thus considered to be a safe and effective procedure for the treatment of inoperable tracheal stenosis.

Analysis of the relationship between cellular thymidine kinase activity and virulence of thymidine kinase-negative herpes simplex virus types 1 and 2

The virulence of thymidine kinase-negative herpes simplex virus type 1 (HSV-1; VRTK- strain) and type 2 (HSV-2; UWTK- strain) was studied in comparison with that of their parental strains (VR-3 and UW-268, respectively) in an encephalitis model of adult (4-week-old) and newborn (3-day-old) mice. Viral thymidine kinase (TK) activity was essential for the maximum expression of virulence of HSV-1, because the 50% lethal dose (LD50) of VRTK- was 60 times higher than that of VR-3 in the brains of newborn mice expressing high levels of cellular TK activity. However, the UWTK- strain showed that replication of the UWTK- strain was completely supported by cellular TK activity. This difference in the role of viral and cellular TKs for virus growth between HSV-1 and HSV-2 was¿ confirmed with the one-step growth of virus strains in L-M and L-M(TK-) cells.

[Mediastinal schwannoma originating from the intrathoracic vagal nerve--a case report and review of the literature]

A 31-year-old woman was operated upon with the diagnosis of mediastinal tumor. The resected specimen revealed pathologically benign schwannoma originating from the right intrathoracic vagal nerve. The postoperative course was uneventful with no complication. Mediastinal schwannoma arising from the vagal nerve is rare. We discussed characteristics of this disease and reviewed the Japanese literature.

Extracorporeal membrane oxygenation for respiratory failure

We report herein our experience with extracorporeal membrane oxygenation (ECMO) for respiratory failure over a 3-year period. ECMO was employed in seven patients: in five for respiratory failure caused by adult respiratory distress syndrome (ARDS), Goodpasture's syndrome, hypoxia after ventricular septal defect closure, interstitial pneumonia, or lung metastasis from choriocarcinoma; and in two for tracheal obstruction. Nafamostat mesilate was used as the main anticoagulant with a small amount of heparin. The period of ECMO support for the five patients with respiratory failure ranged from 54 to 251 h, with an average time of 125 h. Five of the seven patients were able to be weaned from ECMO, and the two who had tracheal obstruction survived. The other three patients who were weaned from ECMO died of underlying diseases or complications 1-25 days after weaning. The complications which occurred during ECMO support were an abnormal electroencephalogram, multiple organ failure, and mediastinitis. Thus, we conclude that ECMO needs to be induced early to obtain a better outcome in patients with respiratory failure, and that it is particularly effective for transient airway obstruction.

Successful surgical management of emphysematous giant bullae accompanied by severe bronchial asthma: report of a case

The surgical treatment of emphysematous lung bullae is usually contraindicated in patients with severe bronchial asthma. However, we recently encountered a patient who required surgery due to the development of respiratory distress despite treatment with bronchodilators and low-dose prednisolone (5 mg/day). During the first operation, bronchospasm occurred with anesthesia. After suppression of the asthmatic symptoms for 2 weeks with high-dose prednisolone (25 mg/day), the giant bullae could be resected safely. Thus, the preoperative resolution of asthma to decrease the probability of an attack is indispensable for such patients.

Activation of protein kinase C stimulates cAMP phosphodiesterase in rat renal collecting tubule

The present study was undertaken to evaluate whether protein kinase C (PKC) affects adenosine 3',5'-cyclic monophosphate phosphodiesterase (cAMP-PDIE) activity in microdissected rat renal medullary collecting tubules (MCT). Phorbol 12-myristate 13-acetate (PMA, 10(-8) M), an activator of PKC, significantly stimulated cAMP-PDIE activity in intact MCT (29.5 +/- 1.5 to 38.3 +/- 3.7 fmol.min-1.mm-1, P < 0.05) but not in the proximal straight tubule [4.7 +/- 0.8 vs. 4.8 +/- 0.8, not significant (NS)] or the medullary ascending limb of Henle's loop (20.5 +/- 2.1 vs. 22.4 +/- 2.8, NS). PMA-stimulated cAMP-PDIE activity was reversed by PKC inhibitors, staurosporine (10(-8) M) and calphostin C (10(-8) M), but not by the cyclooxygenase inhibitor, indomethacin (5 x 10(-6) M). 1,2-Dioctanoyl-sn-glycerol (50 micrograms/ml), a synthetic analogue of diacylglycerol that stimulates PKC, also increased cAMP-PDIE activity in broken-cell preparations from MCT. This stimulation was also suppressed by staurosporine (10(-8) M) and calphostin C (10(-8) M). The stimulatory effect of PMA on cAMP-PDIE activity was lost with rolipram (10(-4) M), a type IV PDIE inhibitor, whereas it was preserved with N-(6-amino-hexyl)-5-chloro-1-naphthalenesulfonamide hydrochloride (W-7) (10(-4) M), a calmodulin inhibitor, or vinpocetin (10(-4) M), a direct inhibitor of type I PDIE. From these results, we suggest that activation of PKC specifically stimulates rolipram-sensitive cAMP-PDIE, but not the calmodulin-sensitive isozyme, in rat MCT.

[Surgical treatment of lung cancer complicated with liver cirrhosis, esophageal varices and pancytopenia: a case report]

Left upper lobectomy and lymph node dissection were successfully performed in a 75-year-old man with lung cancer combined with liver cirrhosis, esophageal varices and pancytopenia. No postoperative complications were encountered due to appropriate fluid transfusion, sufficient administration of fresh frozen plasma and well-chosen antibiotics. In lung operations on patients with liver cirrhosis, it is important to determine the operative indication according to natural history of liver cirrhosis and lung cancer, operative risk and prognosis. Furthermore, the management with special attention to complicated conditions of liver cirrhosis is necessary at the time of surgery.

A simple maneuver in follow-up digital subtraction angiography for multiple coronary-aorta bypass grafts

A simple maneuver in intraarterial digital subtraction angiography (DSA) is proposed to improve the images of left internal thoracic artery bypass grafts (LITAGs). A contrast flush in the left subclavian artery, using a catheter that had been percutaneously introduced from the left brachial artery, was carried out in 14 patients with multiple coronary-aorta bypass grafts (CABGs) after aortic DSA. The side-hole portion of the catheter tip was positioned in the proximal left subclavian artery as the coiled portion remained in the aortic arch. Nonionic contrast medium (350 mg/ml of iodine) was injected with an automatic injector in a volume of 6-8 ml and at a flow rate of 3-4 ml/sec. Left subclavian arterial flush DSA delineated the LITAGs excellently in 11, well in 3, and fairly or poorly in none of the 14 cases. There were no complications in any of these cases. A supplemental contrast flush of the left subclavian artery with a pigtail catheter following aortic DSA improves the diagnosis of multiple CABG patency.

A case of familial ventricular tachycardia

Ventricular tachycardia was noted in 4 members of the same family. One showed diffuse hypokinesis of the left ventricle by echocardiography and left ventriculography, 2 showed progressive left ventricular dysfunction and 1 showed regional perfusion defects of the left ventricle shown by thallium scintigraphy. One patient was diagnosed as dilated cardiomyopathy. Although no definitive cause of the left ventricular disturbance was identified in the 3 other patients, they may have all been dilated cardiomyopathy.

Identification of varicella-zoster virus strains by PCR analysis of three repeat elements and a PstI-site-less region

We established a method of identifying varicella-zoster virus (VZV) strains, especially those of the Oka vaccine, in patients with clinical VZV infections. The DNAs of 30 clinically isolated strains and 4 laboratory strains including the Oka vaccine strain and its parent VZV strain, were analyzed by PCR with four sets of primers for the four variable regions, R2, R4, R5, and a region without a PstI site (PS). R4 was unstable in four laboratory VZV strains and was excluded from the study. The other regions were stable in several passages in cell culture. The number of copies in R2 and R5 were distributed from 2 to 13 and from 1 to 3, respectively, in the strains analyzed. The vaccine strain had seven copies in R2 and two copies in R5, and it was PS negative. Among 30 clinical isolates, 3, 23, and 11 strains had the same characteristics as the vaccine strain in R2, R5, and PS, respectively. Therefore, by this method, 97.2% of the isolates were distinguished from the Oka vaccine strain. This strategy will be useful in diagnosing VZV infections induced by the vaccine strain.

Primary lung cancer SPECT imaging with pentavalent technetium-99m-DMSA

To assess the clinical role of 99mTc(V)-DMSA in primary lung cancers, SPECT imaging was performed on 31 patients with suspected lung cancer.

METHODS

Planar and SPECT images were obtained at 3 to 4 hr after intravenous injection of approximately 555 MBq 99mTc(V)-DMSA. Two uptake ratios (the maximum counts/pixel in the lesion to the average counts in normal tissue) were calculated.

RESULTS

Various types of primary lung cancers (adenocarcinoma, squamous-cell carcinoma, small-cell carcinoma, large-cell carcinoma and bronchial carcinoid tumor) were imaged by 99mTc(V)-DMSA SPECT. Approximately 90% of the lung carcinomas showed increased uptake and were clearly demonstrated by SPECT images. Four cases incidentally revealed osseous metastatic lesion. Three benign lesions did not show increased uptake. Three cases were false-negative and there were no false-positive cases for the primary lesions.

CONCLUSION

Technetium-99m(V)-DMSA SPECT images demonstrated approximately 90% of the primary lung cancers. Uptake ratios were higher in squamous-cell carcinomas than adenocarcinomas. Evaluation of mediastinal tumor extension and nodal metastatic lesion was very difficult by high blood-pool activity in the major cardiovascular structures due to slow blood-pool clearance. However, 99mTc(V)-DMSA SPECT imaging was very useful for detecting primary lung cancers and metastatic lesions to the osseous structures.

[Myasthenia gravis: an analysis of patients with postoperative crisis after thymectomy]

Five patients with myasthenia gravis whose condition declined during the postoperative unstable period were studied. The Osserman's type, age at the time of onset, duration of illness, sex, age at the time of surgery, preoperative steroid therapy, thymoma and acetyl choline receptor antibody titers were compared with those of 21 patients (control) with myasthenia gravis who had an uneventful postoperative course. In comparison, the study group's Osserman's type was slight, age at the time of onset was older (p < 0.05) and duration of illness was shorter (p < 0.05). There was no significant difference between the groups in sex, age at the time of surgery, thymoma and acetyl choline receptor antibody titers. None of them had preoperative steroid therapy. Intensive postoperative management and careful follow-up at the postoperative unstable period are necessary particularly for patients who have slight Osserman's type, old age at the time of onset, short duration of illness and no preoperative steroid therapy.

Prenatal diagnosis and therapy for a patient with vitamin B12-responsive methylmalonic acidaemia

The prenatal therapy is described of a patient with vitamin B12-responsive methylmalonic acidaemia during the last 10 days of gestation with oral administration of vitamin B12 (20 mg/day) given to a mother did not normalize her urinary excretion of methylmalonic acid (MMA), which was 14.5 mmol/mol creatinine at 32 weeks of gestation. Before delivery, the mother was excreting 18.9 +/- 3.3 mmol MMA/mol creatinine (mean value at 7 days after vitamin B12 therapy), as well as at 32-37 weeks of gestation with no therapy. After birth, the level of MMA in the infant's urine was remarkably elevated (500-700 mmol/mol creatinine); the level of MMA in maternal urine decreased dramatically after delivery. Compared with two previous reports, the length of administration was not sufficient to reduce maternal MMA excretion. In future, the length of the therapy, route of administration and total dose of vitamin B12 to maintain an efficient level of vitamin B12 in an affected fetus should be considered.

[A concomitant operation of coronary artery bypass grafting and thymectomy: a case report]

A 63-year-old man was successfully operated upon concomitantly for coronary artery disease and invasive thymoma. The chest roentogenogram showed a mass shadow in the anterior mediastinum, which was 6.0 x 4.0 cm in size and irregular. Coronary angiography revealed complete obstruction of the right coronary artery and 90% stenosis of the first diagonal branch (#9). Following thymectomy combined with the resection of the left phrenic nerve and the mediastinal pleura, coronary artery bypass grafting with the major saphenous vein was performed to #4 PD and #9. This is the first report of concomitant surgery for the ischemic heart disease and invasive thymoma in Japan.

Polysaccharides in Fungi. XXXIV. A polysaccharide from the fruiting bodies of Amanita muscaria and the antitumor activity of its carboxymethylated product

A water-insoluble, alkali-soluble, glucan (AM-APP), [alpha]D +160 degrees in 0.4 M NaOH, was isolated from the alkaline extract of the fruiting bodies of Amanita muscaria. The results of chemical and spectroscopic investigations indicate that AM-APP is a linear (1 --> 3)-alpha-D-glucan with a molecular weigh estimated by gel chromatography of about 42000. Its carboxymethylated product (AM-APP-CM) showed potent antitumor activity against sarcoma 180 in mice, although the native polysaccharide (AM-APP) had little effect. The distribution of carboxymethyl groups in the molecule was analyzed by gas chromatography and mass spectrometry. The degree of substitution of carboxymethyl groups was 0.95 and the substituents were located at O-2, at O-4, at O-6, at O-2 and O-6, and at O-4 and O-6 on glucose.

Formation of anti-sense RNA to IFN mRNA in poly (rI):(rC) induced HEL cells

To elucidate the mechanism of super induction of IFN, mRNA and anti-sense RNA were analyzed by using reverse transcription-polymerase chain reaction (RT-PCR) method, and following results were obtained. (1) When human embryonic lung fibroblast cells (HEL cells) were exposed to poly (rI):(rC) for 1 hr, treated with cycloheximide for 3 hr, treated with actinomycin-D for 30 min at the final period of cycloheximide treatment, then washed and replenished with maintenance medium, (HEL-I:C/CH/Act. D), they produced much higher amount of IFN and IFN production continued for longer period when compared to the HEL cells which were not treated with actinomycin-D (HEL-I:C/CH). In agreement with these IFN production kinetics, HuIFN-beta mRNA was stabilized in HEL-I:C/CH/Act. D. In HEL-I:C/CH/Act.D, the mRNA was detected at the end of cloheximide treatment (4 hr after induction) and 6 hr after induction, however, it was not detected at 6 hr after induction in HEL-I:C/CH. (2) Anti-sense RNA was detected in HEL-I:C/CH/Act.D at 4 hr and 6 hr after induction, and also in HEL-I:C/CH at 4 hr after induction, however, it was not detected at 6 hr after induction in HEL-I:C/CH. These results indicated that an anti-sense RNA to HuIFN-beta mRNA was formed in poly (rI):(rC) induced HEL cells, and that aRNA had the same fate as mRNA, suggesting it's role in the regulation of IFN production. Possible role of aRNA in the regulation mechanism of IFN production was discussed.

[Surgical treatment of needles in intracardiac cavity and chest wall--a case report and the review of cases removed under open-heart surgery in Japan]

A 36-year-old woman under the treatment for neurosis stuck five sewing needles into her left anterior chest wall for the purpose of suicide. She was hospitalized with complaints of anterior chest pain and low-grade fever. Chest roentgenogram and computed tomogram showed two needles in the cardiac cavity and three needles in the chest wall. Following extraction of three needles in the chest wall, we removed two needles from the left and the right ventricular cavities under extracorporeal circulation. Preoperative and intraoperative two-dimensional echocardiography was useful for confirming the location of needles.

[Lung cancer with pleural dissemination diagnosed by thoracofiberscopy: a case report]

Pleural dissemination was suspected in a 39-year-old woman with pulmonary adenocarcinoma. Thoracofiberscopy provided the preoperative exact diagnosis of pleural dissemination and the following prepare operative procedure. Thoracofiberscopy is effective for the diagnosis of pleural dissemination and the selection of operative methods in patients with pulmonary cancer.