Severe Kawasaki heart disease treated with an internal mammary artery graft in pediatric patients. A first successful report

Two Japanese boys, 6 and 10 years old, required operation for severe Kawasaki heart disease. Both had multiple coronary arterial aneurysms and stenoses, and one had mitral regurgitation as well. The operations consisted of anastomosis between the left internal mammary artery and the left anterior descending artery and insertion of an autologous saphenous vein between the aorta and the posterior descending artery in both patients. The mitral valve was replaced in the one with mitral regurgitation. Angina pectoris has been completely relieved as confirmed by postoperative angiocardiography. Late results of coronary bypass grafting with the saphenous vein in pediatric patients with Kawasaki disease have been less than satisfactory because of the high occlusion rate of the graft. The internal mammary artery may be superior, at least theoretically, to the saphenous vein graft because it is a "living graft" with a high possibility of growing and with less susceptibility to degeneration. This is the first report of successful operation utilizing an internal mammary artery graft in coronary bypass for Kawasaki disease.

Pineal germinoma with widespread extracranial metastases

A case of primary pineal germinoma with widespread extracranial metastasis in a 36-year-old man is presented. A clinical work-up revealed bilateral pleural effusions, ascites, and metastatic lesions involving the lung. Cytology and electron microscopic study of the pleural and ascitic fluid and of the fine needle aspiration material revealed metastatic germinoma. Although the cytologic features were not distinct from those of anaplastic carcinoma, they were distinguishable from those of glial neoplasms, lymphoma, and sarcoma. The computed tomography findings, elevated human chorionic gonadotropin level, and electron microscopic features contributed significantly to the diagnosis of extracranial metastasis of the pineal germinoma. Metastatic spread most likely occurred via the ventriculoperitoneal shunt.

In vitro luteinizing hormone-releasing hormone release from superfused rat hypothalami: site of action of progesterone and effect of estrogen priming

The study examined the effect of estrogen priming on progesterone (P4)-induced LHRH release, the tissue site of action of P4, and the effect of 5 alpha-dihydroxyprogesterone (5 alpha-DHP) on LHRH release from hypothalamic fragments superfused in vitro. Immature female rats were ovariectomized (OVX) and, at 28 days of age, Silastic capsules containing estradiol (E2) were implanted. Two days later, animals were killed and hypothalamic fragments were removed and transferred to superfusion chambers. The hypothalamic units received P4 or 5 alpha-DHP delivered in an intermittent mode (10-min on, 20-min off). LHRH was determined in perfusates by RIA. After the input characteristics of different infusion modes (single pulses, intermittent, and continuous) of P4 infused into superfusion chambers were assessed, an intermittent infusion mode (10-min on, 20-min off) was selected for further examinations. In the mediobasal hypothalamic-anterior hypothalamic-preoptic area (MBH-AHA-POA) tissue preparations, we observed: 1) an infusion of 5 alpha-DHP was ineffective in stimulating LHRH release; 2) the release pattern of LHRH in response to three different P4 doses (10, 20, and 50 ng/ml) was similar in terms of percent changes (202% to 219% over control values); and 3) E2 priming was absolutely required for P4-stimulated LHRH release, and this requirement appeared to be dose dependent. Upon an examination of three hypothalamic tissue boundaries [the MBH, the POA-suprachiasmatic nuclei (POA-SCN), and the median eminence (ME)] to better delineate the in vitro site of action of P4 on LHRH release, it was demonstrated that the MBH responded upon P4 infusion, whereas the POA-SCN was unable to do so. The ME also responded upon P4 infusion, and LHRH release followed closely the pulsatile administration of P4 since upon each challenge of the steroid at the concentration of 10 or 20 ng/ml, a significant rise in LHRH release occurred. However, the temporal patterns of LHRH release from the ME appears to be different from those obtained from the MBH as well as the MBH-AHA-POA. These observations demonstrate that an intermittent infusion of P4, but not 5 alpha-DHP, is effective in activating the neural LHRH apparatus. Estrogen is an obligatory requirement for this P4-stimulated LHRH release, and the neural site of action of P4 resides within the MBH. However, this steroid also can act directly upon the ME nerve terminals to release LHRH.

Caffeine-induced reorganization of DNA replicating system occurs on or near nuclear matrix in HeLa cells

Since caffeine reorganizes the DNA replicating system, with several consequences, we studied the effect of caffeine on the DNA replication which normally occurs on or near the nuclear matrix in a variety of eukaryotic cells. When HeLa cells, treated with or without the DNA-damaging agent, neocarzinostatin, were postincubated in the presence or absence of caffeine and then pulse-labeled with [3H]thymidine, the DNA remaining tightly associated with the matrix was enriched in the newly synthesized DNA at the same level as that seen in untreated cells. The nuclear matrix-bound DNA polymerase alpha activity was also the same in these cells. Therefore, in the presence of caffeine, DNA replication, with or without DNA damage, also occurs on or near the nuclear matrix, as is the case in normal DNA replication.

Novel system for recognizing and eliminating foreign DNA in Pseudomonas putida

Derivatives of pQSR49 (R1162::Tn1) containing cloned fragments of Escherichia coli chromosomal DNA are stable in E. coli but unstable in Pseudomonas putida. Similar derivatives containing P. putida chromosomal DNA are stable in both species. Instability is a consequence of plasmid loss during growth and is not due to death or inhibition of growth of plasmid-containing cells. Average copy numbers per cell of the unstable hybrid plasmids are similar to that of pQSR49, indicating that instability is not the result of reduced replication of plasmid DNA. A plasmid unrelated to pQSR49, RK2, becomes unstable in the presence of the unstable hybrids but only when it also contains foreign DNA. The data suggest an inducible mechanism in P. putida active in the elimination of plasmid-borne foreign DNA from the cell.

Enhanced immune response in the urinary tract of the rat following vaginal immunization

The immune response in the rat urinary tract was assessed by an enzyme-linked immunosorbent assay for immunoglobulins following vaginal immunization and subsequent intravesical challenge with live E. coli 06. Vaginally immunized rats showed a strong and rapid bladder immune response following intravesical challenge, in contrast to nonimmunized control rats. The immune response was localized to the urinary tract in that antibody to E. coli 06 was not detected in serum, saliva and vaginal washes from immunized rats.

Pre- and postoperative hemodynamic assessments and survival rates in patients with postinfarction ventricular septal perforation

Pre- and postoperative hemodynamics were assessed in 14 consecutive patients who developed ventricular septal perforation (VSP) following acute myocardial infarction (AMI). Results were correlated with the surgical outcome and with postoperative clinical improvements. The patients were divided into 3 groups according to the time intervals between the onset of AMI and the operation; acute (within 2 weeks after AMI), subacute (between 2 and 4 weeks) and chronic (after 4 weeks). In the above groups, 6, 2 and 6 patients were included, respectively. Eleven patients had anteroseptal infarction and 3 patients sustained inferior infarction. The survival rates were 33, 50 and 100% in the acute, subacute and chronic groups, respectively with an overall survival rate of 64%. Hemodynamic comparisons between survivors and non-survivors revealed that the systolic aortic pressure and left ventricular stroke volume index were significantly higher and the right ventricular end-diastolic pressure was significantly lower in survivors than in non-survivors (p less than 0.05). Although no statistical significance was obtained, left ventricular end-diastolic volumes and ejection fractions were higher in survivors. No difference was present between survivors and non-survivors in either Qp/Qs, Pp/Ps, Rp/Rs, systolic pulmonary pressure, left ventricular end-diastolic pressure or cardiac index. Patients with low arterial pressure and high right ventricular end-diastolic pressure under intensive medical regimens, indicating the presence of cardiogenic shock and/or associated right ventricular infarction or severe failure, had a high mortality and should be considered for emergency operation. Postoperative hemodynamics improved significantly in all variables measured (p less than 0.05-0.01). Patients with a VSP should all be considered for surgery unless a definite contraindication exists.

In vitro and in vivo neutralizing activity of human colostrum and milk against purified toxins A and B of Clostridium difficile

The neutralizing activity (NA) of supernates of colostral samples collected postpartum from 55 women and tested against a 50% cytopathic dose of purified toxins A and B of Clostridium difficile was evaluated in Y1 adrenal cells. Thirty-one (56%) of the samples had NA against one or both toxins. Samples of breast milk were collected postpartum from five women-three had colostral NA and two did not. All milk specimens from the three women with colostral NA had NA titers of 1:1-1:4 throughout the study (609 days in one case). Samples from the two women without colostral NA did not exhibit NA during a 60-day follow-up period. In suckling mice either toxin plus human milk with in vitro NA elicited significantly less fluid accumulation than did toxin plus diluent or toxin plus milk without in vitro NA (P less than .025 to P less than .05). Twelve (63%) of 19 milk samples with in vitro NA against toxin A and 15 (65%) of 23 with in vitro NA against toxin B inhibited fluid accumulation caused by the corresponding toxin. In vitro NA against toxin A appeared to reside in the secretory IgA fraction of one milk sample assessed by immune precipitation. The results suggest that human milk may protect newborn infants against toxins A and B of C. difficile.

Idiopathic aldosteronism. A possible disease of the intermediate lobe of the pituitary

A 37-year-old woman with documented primary aldosteronism died of a cerebral hemorrhage. At postmortem examination she was found to have bilateral, adrenal hyperplasia and nodular basophilic hyperplasia of the anterior and intermediate lobe of the pituitary. Based on these findings and experimental evidence suggesting the existence of a pituitary factor that stimulates aldosterone secretion, we postulate that idiopathic aldosteronism is caused by an abnormality of the intermediate lobe of the pituitary gland leading to overproduction of non-adrenocorticotropic hormone peptides derived from pro-opiomelanocortin that increase aldosterone production and cause hyperplasia of the adrenal glands.

Primary myelolipoma of mediastinum

Myelolipoma is a benign nonepithelial neoplasm composed of mature marrow elements and fat cells. This rare neoplasm is usually discovered by pathologists incidentally at autopsy, and, with rare exceptions, usually occurs in the adrenal glands. One of these exceptional anatomic sites is the mediastinum, and only three cases of primary mediastinal myelolipomas have been documented in the English-language literature (1-3). We are presenting a primary myelolipoma involving the posterior mediastinum that was discovered on routine chest radiographs and successfully resected. Computed tomography (CT) scan findings of this rare mediastinal tumor are also presented. This is the first case report in the English language of primary myelolipoma in the mediastinum that was detected clinically and resected successfully.