The endoscopic removal of a foreign body in the pericardial cavity following cardiac surgery

We were able to successfully remove a needle and suture through a pericardial drain following cardiac surgery by means of a simple method using a bronchofiberscope without having to perform a re-median sternotomy. The technique of endoscopic removal of cardiac surgical misplacement is described.

Mutants of smooth muscle myosin light chain kinase at tryptophan 800

The importance of Trp 800 in the calmodulin-binding site of myosin light chain kinase was investigated. Truncation mutants from Leu 447 to the C-terminus were expressed in E. coli and these were modified by point mutations of Trp 800 to Gly, Cys, Leu and Tyr. Trp at this position was more effective than any of the other residues. The Leu mutant was partially active and its Km for calmodulin decreased from about 10 nM to 175 nM. The Tyr mutant had detectable activity but the other two mutants were inactive and did not bind calmodulin. Thus Trp at position 800 is critical. The activity of the Leu mutant at high calmodulin concentrations was less than the wild-type mutant, about 20%. This suggests that the binding of calmodulin does not release inhibition in an all-or-none mechanism and that other intramolecular interactions are important.

Protein kinase C delta- and epsilon-subspecies in rat central nervous tissue; differential distribution and phorbol ester-induced redistribution in synaptosomes

Distribution of the delta- and epsilon-subspecies of protein kinase C (PKC) in rat central nervous tissues was semiquantitated by an immunoblot analysis. The epsilon-subspecies, which is expressed predominantly in the brain, was abundant in hippocampus and cerebral cortex among rat brain areas, whereas the delta-subspecies, which is expressed ubiquitously in many tissues, showed no significant difference among tissue areas tested. Unlike other subspecies, the delta-subspecies was primarily associated with particulate fractions. Subcellular fractionation analysis revealed that both the epsilon- and delta-subspecies were enriched in the synaptosomal P2 fraction. Treatment with 12-O-tetradecanoyl-phorbol 13-acetate (TPA) induced translocation of the epsilon-subspecies from cytosolic fraction to membrane fraction. In contrast, upon treatment with TPA, the delta-subspecies normally bound to membrane fraction was released into cytosol.

Congenital aortic regurgitation caused by a rudimentary noncoronary cusp: report of a case

A 14-year-old asymptomatic boy was admitted to our department for investigation of a diastolic murmur which had been discovered by his family doctor during a routine examination. Echocardiography showed aortic regurgitation with dilatation of the left ventricle. Inspection of the aortic valve at the time of operation revealed normal left and right cusps with a rudimentary noncoronary cusp. An aortic commissuro-plication was performed and a new bicuspid aortic valve successfully reconstructed. His postoperative course was uneventful and he has been well and leading an active life since his discharge from hospital.

Immunohistochemical studies on sympathetic and non-sympathetic nerve fibers and neuronal cell bodies in the pineal gland of cotton rats, Sigmodon hispidus

Immunohistochemistry revealed the presence of tyrosine hydroxylase (TH)-, neuropeptide Y (NPY)-, calcitonin gene-related peptide (CGRP)- and substance P (SP)-immunoreactive nerve fibers and SP-immunoreactive neuronal cell bodies in the pineal gland of the cotton rat (Sigmodon hispidus). Abundant TH- and NPY-immunoreactive fibers were distributed evenly throughout the gland; less numerous CGRP- and SP-immunoreactive fibers were distributed in the superficial pineal and the stalk, but were scarce in the deep pineal. All the immunoreactive fibers were usually found around blood vessels. Since TH- and NPY-immunoreactive fibers in various pineal regions disappeared completely with superior cervical ganglionectomy, these fibers are all considered postganglionic sympathetic fibers. Intrapineal CGRP- or SP-immunoreactive fibers decreased considerably in number following superior cervical ganglionectomy, suggesting that some sympathetic fibers contain CGRP or SP. Bilateral bundles of nerve fibers under the transverse sinuses, corresponding to the nervi conarii, contained TH-, NPY-, CGRP- and SP-immunoreactive fibers, which continued into those distributed in the pineal capsule. In the nervi conarii, fibers immunoreactive for TH and NPY disappeared after superior cervical ganglionectomy, but those immunoreactive for CGRP and SP persisted. Thus, non-sympathetic, CGRP- and SP-immunoreactive fibers, together with sympathetic fibers, are presumed to enter the gland by way of the nervi conarii. Neuronal cell bodies, containing SP-like immunoreactivity and being possibly parasympathetic in nature, occurred occasionally in the superficial pineal.

S100 protein positive human breast carcinomas: an immunohistochemical study

An immunohistochemical study for S100 protein was performed on 95 human breast carcinomas. S100 protein positive carcinoma cells were recognized in 54 cases (57%). The S100 protein positive and negative carcinomas were then compared in terms of stage, histologic type, nuclear grade, appearance of minute calcification, immunoreactivity for estrogen receptor (ER), tumor recurrent pattern, and prognosis. The S100 protein positive cases had a tendency to show a low nuclear grade (P < 0.01). They were also more often seen in the ER positive group. For further analysis of the nature of S100 protein positive carcinoma cells, immunoreactivity for neuron-specific enolase (NSE) and actin was investigated. The positive staining for NSE and actin was seen in 46 cases (48%) and 3 cases (3%), respectively. There was, however, no specific correlation among the S100 protein. NSE, or actin staining. The nature of S100 protein positive carcinoma cells still remains unclear. The S100 protein positive carcinomas, however, exhibit relatively better characteristics.

[A case of partial anomalous pulmonary venous return to inferior vena cava and left atrium (Scimitar syndrome)]

Scimitar syndrome is relatively uncommon syndrome. A 14-year-old female referred to our hospital for abnormal shadow of chest fluoroscopic examination. She had no symptom except cough due to bronchial asthma. Chest X-ray film showed Scimitar sign. Cardiac catheterization revealed 30% left to right shunt without atrial septal defect. Pulmonary angiography showed anomalous pulmonary vein was drained to inferior vena cava and left atrium. Surgical correction was attempted monitoring the pulmonary arterial pressure. Anomalous pulmonary vein and systemic arteries were ligated and divided at the level of diaphragm. Postoperative course was smooth. We have found 4 similar operated cases previously reported in the world.

[A case of subtotal esophagectomy for esophageal basaloid carcinoma after mitral valve replacement]

We reported a rare case of subtotal esophagectomy for esophageal basaloid carcinoma after mitral valve replacement. Up to present, only this case had been printed in Japan. A 51-year-old male who had been performed MVR for mitral stenosis at the 44 complained of dysphagia. On esophageal X-ray and esophagoscopic findings showed round, irregular, and stenotic lesion (type-3) in the middle thoracic esophagus. We performed subtotal esophagectomy, esophagogastrostomy through the posterior mediastinal pathway and lymph node dissection (R2). Despite normal cardiac function before operation, the patient followed lung edema and perioperative measurement of Extra Vascular Lung Water Index (EVLWI) was stable within high level. On microscopic inspection, we revealed lots of basophilic basal cells mainly occupied submucosal layer coexisted with pseudoglandular formation and poorly differentiated squamous cell carcinoma. And the tumor cells strongly invaded into the lymph ducts and blood vessels. We need more detailed exploration for more cases about factors causing poor prognosis.

[Treatment of thoracic malignancy accompanied with cardiovascular disease]

We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease.

[A case of simultaneous association of an early esophageal carcinoma and an early gastric carcinoma with radical operation]

We encountered a case of simultaneous association of an intraepithelial esophageal carcinoma and an intramucosal gastric carcinoma with radical operation. Up to present, only four cases including this report had been printed in Japan. A 67-year-old with chronic cholecystitis was pointed out the esophageal lesion (O-IIa) in the Im area by FGS after it had demonstrated the gastric lesion (early I) at the posterior wall of the prepyrolus. We performed subtotal esophagectomy, total gastrectomy, pyroloplasty with esophagoileostomy through the retrosternal tunnel and lymph nodes dissection (R2). On gross inspection, there was no obvious lesion in the esophagus. Microscopic examination revealed no invasion of cancerous cells to lymph nodes, lymph ducts, and vessels. The patient followed post operative respiratory disorders which not lung edema but atelectasis caused because perioperative measurement of Extra Vascular Lung Water Index (EVLWI) was stable within normal values.

Effect of magnetic field on pineal gland volume and pinealocyte size in the rat

Light microscopic observations on the superficial pineal gland of Wistar-King rats were made to examine whether or not pineal volume and pinealocyte size, expressed as nuclear density, at daytime or nighttime are affected by long-term exposure to 50 Hz rotating magnetic field (MF) at 5.0 microT. Determinations of pineal volume and pinealocyte size were repeated twice (April and October) during the year. Size of pinealocytes in MF-exposed and sham-exposed rats exhibited, in addition to the difference between peripheral and central regions, regional differences in a proximodistal direction; pinealocytes in the distal and middle-peripheral regions were usually larger than those in the proximal and middle-central regions at daytime or nighttime. In October, distal and proximal pinealocytes showed significant day-night changes in size in sham-exposed rats, but not in MF-exposed animals. The situations in the two groups were almost reversed in April. Significant day-night differences were scarcely found in pinealocyte size in the middle region in the two groups. Throughout the study, pineal volume and pinealocyte size in each region were generally the same between MF-exposed and sham-exposed rats at daytime or nighttime. The results suggest that pinealocytes in the distal and proximal regions, but not those in the middle region, are affected by MF-exposure; day-night differences in sizes of distal and proximal pinealocytes appear in April and disappear in October under the influence of MF. MF may exert an effect on mechanisms controlling day-night rhythms of pinealocyte size in the rat.

[Combined superior-transseptal approach to the mitral valve]

We report a technique to improve exposure of the mitral valve apparatus. This technique that combines superior left atriotomy and interatrial septotomy can be helpful in patients with a small left atrium and reoperation. It has been used effectively in five patients and potential complication with this procedure has not occurred. The operative technique and indication are discussed in this paper.

[Intraoperative use of real-time ultrasonography in neurosurgery: with special reference to head injury and intracerebral hemorrhage]

We used B mode ultrasonography during 61 craniotomies performed in the acute stage after head injury, intracerebral hemorrhage, ruptured cerebral aneurysm and so on. We examined intracerebral lesions, new hemorrhages near the operative field, and contralateral hemorrhages appearing simultaneously intraoperatively. The resolution with ultrasonography was similar to that of CT and had few obstructing artifacts. It was easy to use and very useful for diagnosing abnormal intracranial mass lesions during craniotomy, mainly for the acute stage of head injury or intracerebral hemorrhage.

[The influence of left atrial cuff rejection on pulmonary hemodynamics after canine lung allotransplantation]

Several factors influence pulmonary hemodynamics after lung transplantation: reimplantation response, lung rejection reaction and imperfect anastomosis technique. In this experiment, five cases presented marked elevation of mean pulmonary artery pressure at the time or right pulmonary artery occlusion test performed two weeks postoperatively. Left atrial cuff rejection reaction arose in one case in which edema and stenosis of the pulmonary vein outflow tract were evidenced. This finding demonstrated that the changes in pulmonary hemodynamics after transplant suggest the possibility of inducement by left atrial cuff rejection reaction.

Postnatal changes in nerve cells and myelinated fibers in the pineal gland of cotton rats (Sigmodon hispidus). A light microscopic study

Intrapineal neurons and intracapsular and intrapineal myelinated fibers were studied by light microscopy in male cotton rats (Sigmodon hispidus) at various postnatal ages. Until 300 days of age, neurons are encountered mainly in the distal third of the organ; neuronal nuclei are largest in this region. The remaining regions contain only a few neurons with smaller nuclei. In all regions, nuclear sizes of the neurons increase, and neuronal numbers reduce by half until 100-200 days. Neurons thus consist of different populations of cells, and the aging changes in neuronal nuclei seem to be related to the differentiation of the organ. The disappearance of neurons and the enlargement of the nuclei of remaining neurons proceed simultaneously with age. Intracapsular and intrapineal myelinated fibers appear at 20 days and their density increases with age. As the myelinated fibers are distributed mainly in the distal region and its capsule, these fibers are related topographically to intrapineal neurons. The intracapsular myelinated fibers continue into bilateral bundles of myelinated fibers found under the transverse sinuses, corresponding to the nervi conarii. Since the intracapsular fibers and the fibers traced between the capsule and the parenchyma bifurcate in a proximal direction, the intracapsular fibers are considered to run proximally, some entering the organ.

[Clinical experience of intramediastinal injection therapy via mediastinoscope for lung cancer]

As local treatments other than surgery, radiation therapy, bronchial artery infusion and intrabronchial injection of anti-cancer drugs have generally been administered to inoperative lung cancer cases. Together with these local therapies, we experienced six cases of intramediastinal injection. Indication of this therapy has been fundamentally limited to the inoperative cases in which patient performance status has deteriorated. Histologically, three cases were squamous cell carcinoma and three cases were adenocarcinoma. Injection therapy was effective in four cases where we noted alleviation of atelectasis and obstructive pneumonia brought on by the tumor, and a tendency of the tumor and swelling lymph nodes to be reduced. No side effects nor complications were evidenced. This therapy is characterized by a wider injection area in which intrabronchial injection is incapable of reaching the upper mediastinum, the bifurcation and the upper side of the hilus. The results suggest that this therapy should be used alone or together with other local therapies and prior to operation.

Urinary salt excretion and stomach cancer mortality among four Japanese populations

A relationship between salt intake and the occurrence of stomach cancer has been suggested by both epidemiologic and experimental data. To test this hypothesis, urinary excretion of salt in 24 hours and dietary intake of salt were measured in four male populations with different levels of stomach cancer mortality. Age-adjusted mortality rate of stomach cancer showed a high correlation (r2 = 0.995) with the average amount of salt excretion in 24-hour urine. This strong correlation, however, was not shown (r2 = 0.265) with dietary salt intake calculated from the standard food-composition table. The results confirmed the important role of salt in the development of stomach cancer in Japan, and raised the problem of evaluating the level of salt intake by using the uniform composition table.

Nonspecific giant ulcer of the sigmoid colon--a case report

An unusual case of a 44 year old woman who developed a nonspecific ulcer of the sigmoid colon is reported herein. She presented with lower abdominal pain and fever and colonoscopy revealed a large, sigmoid colon ulcer with normal surrounding mucosa and a well-defined margin. A temporary sigmoidostomy was done to decompress the bowel content and, after the abdominal pain and fever had subsided, the involved segment with an ulcer of 6.1 X 2.5 cm was resected. Her postoperative course was uneventful and she has remained well since.