Platelet aggregability and the occurrence of anastomotic leakage after esophageal reconstruction

In 21 patients who had undergone resection and reconstruction for esophageal carcinoma, the postoperative platelet aggregability was measured and the correlation between the occurrence of anastomotic leakage and platelet aggregability was investigated. There was no statistical difference in the clinical features of the patients between those with (n = 5) and without (n = 16) anastomotic leakage. Platelet aggregability was measured by the turbidimetric method from blood samples taken preoperatively, and at 1, 3, and 7 postoperative days (POD). The average values of platelet aggregability in patients without anastomotic leakage were 81.2, 70.4, 80.1, and 81.8%, while those with leakage were 81.3, 47.6, 52.3, 70.6% preoperatively, and 1, 3, and 7 POD, respectively. Thus, platelet aggregability significantly decreased in patients with anastomotic leakage on the first postoperative day (p < .05), and then gradually recovered postoperatively as time passed. Therefore, the measurement of platelet aggregability is considered to be one of the parameters predicting the occurrence of anastomotic leakage, and a prevention in the decrease of platelet aggregability as well as its activation could become a treatment for preventing anastomotic leakage.

[Potential organ donors at an Italian intensive care unit]

AIM

To determine evaluate the number and characteristics of the population diagnosed as being cerebrally dead and the reasons why organs were not donated.

EXPERIMENTAL DESIGN

Retrospective study from 1.1.1990 to 31.5.1994.

SETTING

Intensive care ward at Arezzo Hospital.

PATIENTS

46 patients diagnosed as being cerebrally dead owing to primary intracranial pathology.

RESULTS

Of the 1256 patients admitted to intensive care, 46 were diagnosed as being cerebrally dead. Five became organ donors. The study examines the reasons why the organs of the remaining patients dwere not donated.

CONCLUSIONS

In spite of the fact that the number of donors corpses was broadly in line with national figures (8 per million inhabitants versus 9.7 for the NITp average and 6 for the national average), it is worth underlining the high percentage of patients (26.8%) for whom it was not possible to identify the reasons why the commission for the ascertainment of cerebral death was not summoned. This emphasises the need for greater commitment in the early identification of cerebral death, the monitoring and maintenance of organ functions in potential donors, and likewise the need for increased clarity in the formulation of statutory requirements regarding cerebral death.

Neural invasion in gastric carcinoma

AIMS

To determine whether neural invasion in advanced gastric cancer is of clinicopathological significance.

METHODS

The study population comprised 121 cases of primary advanced gastric carcinoma. Two paraffin wax embedded blocks taken from the central tissue slice in each primary tumour were used. For definitive recognition of neural invasion, immunostaining for S-100 protein was applied to one slide; the other slide was stained with haematoxylin and eosin.

RESULTS

Neural invasion was recognised in 34 of 121 (28%) primary gastric carcinomas. There were significant differences in tumour size, depth of tumour invasion, stage, and curability between patients with and without neural invasion. The five year survival rates of patients with and without neural invasion were 10 and 50%, respectively. Multivariate analysis, however, demonstrated that neural invasion was not an independent prognostic factor.

CONCLUSIONS

Neural invasion could be an additional useful factor for providing information about the malignant potential of gastric carcinoma. This may be analogous to vessel permeation which is thought to be important, but is not an independent prognostic factor.

Acute myeloblastic leukemia associated with an intermediate state between the healthy carrier state and adult T-cell leukemia

This report describes an intermediate state between the human T-cell lymphotropic virus type I (HTLV-I) healthy carrier and adult T-cell Leukemia (ATL) who developed acute myeloblastic leukemia (AML, FAB subtype M2). The polyclonal integration of HTLV-I proviral DNA was demonstrated in the peripheral blood lymphoid cells, whereas AML cells had no HTLV-I proviral DNA. The patient achieved remission after combination chemotherapy but cells with lobulated nuclei persist at a low level and the polyclonal integration of HTLV-I proviral DNA is still demonstrated. We suggest that the patients with the integration of HTLV-I proviral DNA might develop secondary neoplasms more frequently than healthy carriers and this case stresses the need to exercise caution with these patients. The relationship between HTLV-I and AML is briefly discussed.

Changes in IL-6 and IL-8 after hepatectomy in patients with liver cirrhosis

Changes in tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and interleukin-8 (IL-8) were investigated before and after hepatectomy in patients with or without liver cirrhosis (5 cases without liver cirrhosis and 14 cases with liver cirrhosis). Both the IL-6 and IL-8 values of the cirrhotic patients were significantly higher on the first postoperative day (POD) as compared with the non-cirrhotic patients. Overall, no significant correlation was found between peak values of IL-6 or IL-8 and blood loss or operating time. In the case of the cirrhotic patients, correlation of both IL-6 and IL-8 with operating time was significant at p < 0.05, gamma = 0.534 and 0.586, respectively. No correlation was found between blood loss and the peak value of IL-6, but significant correlation (gamma = 0.647, p < 0.05) was found between them in cirrhotic patients. There was no consistent increase in TNF-alpha and IL-1 beta following hepatectomy. These findings indicate that procedures undertaken to reduce the excessive production of these cytokines may be useful for preventing complications after hepatectomy in cirrhotic patients.

Involvement of spontaneous nitric oxide production in the diabetogenic action of streptozotocin

The exact mechanism by which streptozotocin (STZ) destroys pancreatic beta-cells has not been determined. Recently, nitric oxide was identified as a potent islet toxic compound. However, nitric oxide production by STZ has not been proved yet. In the present studies, we determined whether STZ spontaneously produces nitrite, measured by a spectrophotometric technique based on the Griess reaction. STZ, dissolved in the pH 4.0 citrate buffer, produced significantly more nitrite than that dissolved in pH 7.4. After incubation at 37 degrees C for 120 min, nitrite concentrations were significantly decreased only in STZ dissolved in the pH 7.4 citrate buffer. Following 120 min incubation at 37 degrees C, STZ dissolved at pH 7.4 failed to cause significant islet damage in rats previously deprived of food for 18 h. The present studies demonstrated that STZ may spontaneously produce nitrite in vitro. Nitric oxide production may, at least in part, be responsible for the STZ-induced damage of pancreatic beta-cells of the rodents.

Malignant lymphoma of the rectum treated preoperatively with hyperthermia and radiation

A 58-year-old Japanese woman with primary malignant lymphoma of the rectum was treated preoperatively with radiation and intraluminal hyperthermia, after which abdominoperineal rectal amputation (Miles' operation) was done. The rectal tumor disappeared and there were no lymphoma cells in the resected specimens. The postoperative course was smooth and she is being followed in the outpatient department. At this writing, five years after the surgery, she remains well.

Hepatopancreatoduodenectomy for squamous and adenosquamous carcinoma of the gallbladder

The characteristics of squamous or adenosquamous cell carcinoma of the gallbladder differ quite markedly from those of adenocarcinoma, although the incidence is extremely low. Recently, we encountered both of the former types of gallbladder carcinoma: a 77-year-old man with squamous cell carcinoma and a 70-year-old man with adenosquamous cell carcinoma of the gallbladder. Both had a large mass in the gallbladder fossa region with infiltration to the liver and invasion of the duodenum. Hepatopancreatoduodenectomy was performed on both of these patients. The TNM stage of the former was IV (T4N0M0) and of the latter IV (T4N0M0) and of the latter IV (T4N1bM0). The former has remained well without recurrence for about 1 year and 4 months after the operation, while the latter died of recurrent disease 6 months after operation. The true reason for the difference in the prognosis of these two patients was not known. However, hepatopancreatoduodenectomy is considered to be a most adaptable operative procedure for squamous or adenosquamous cell carcinoma of the gallbladder in view of their mode of spread, and the presence of lymph node metastasis might be a factor of poor prognosis.

Importance of ornithine transcarbamylase (OTC) deficiency in small intestine for urinary orotic acid excretion: analysis of OTC-deficient spf-ash mice with OTC transgene

We report the effect of the ornithine transcarbamylase (OTC) transgene composed of 1.3 kb of the 5' flanking region of the rat OTC gene fused to rat OTC cDNA on urinary orotic acid excretion in OTC-deficient spf-ash (sparse-fur with abnormal skin and hair) mice during overnight-starvation and nitrogen loading. During starvation, spf-ash mice with about 6% and 2% of control levels of OTC activity in the liver and small intestine excreted a large amount of orotic acid in the urine. Transgenic spf-ash mice with about 10% and 30% of the control OTC activities in the liver and small intestine did not excrete more than the normal level of orotic acid. Accidental parasitization of transgenic spf-ash mice with ticks (Myocoptes musculinus) resulted in decrease of the OTC activities in the liver and small intestine to the levels in spf-ash mice, and increased excretion of orotic acid. During extermination of the ticks, the mice showed varied levels of OTC activity and orotic acid excretion. On nitrogen loading, transgenic spf-ash mice as well as spf-ash mice excreted larger amounts of orotic acid, while control mice showed no increase in its excretion. The levels of urinary orotic acid were inversely correlated to the logarithms of the OTC activities in the liver and small intestine, the correlation being significantly higher with intestinal OTC than with hepatic OTC activity. These results suggest that the level of OTC activity in the small intestine is important for production of orotic acid.

Regional differences in cerebral vasomotor control by nitric oxide

Regional differences in the role of nitric oxide in cerebral vasomotor control were investigated with a nitric oxide synthesis inhibitor, NG-monomethyl-L-arginine, or a precursor of nitric oxide, L-arginine using both dog cerebral angiography for the larger artery study and rat isolated arterioles for the microcirculation study. NG-monomethyl-L-arginine (10 mumol) constricted the dog cerebral arteries, by 15.6%, 17.5%, and 27.3% in the middle cerebral, anterior cerebral, and basilar arteries, respectively. The greater constriction of the basilar artery did not reach statistical significance. However, L-arginine (100 mumol) produced significantly greater dilation of basilar arteries than the middle cerebral or anterior cerebral (31.3% vs. 16.7% or 13.1%). NG-monomethyl-L-arginine at 10(-3) M constricted rat arterioles originating from basilar arteries significantly more than the middle cerebral arteries (23% vs. 14%). L-arginine at 10(-3) M dilated rat arterioles from basilar arteries significantly more than from the middle cerebral artery (24 vs. 11%). These findings suggest that the roles of nitric oxide in vasomotor control differs by region in the brain, and it may be greater in vessels of the posterior than of the anterior circulation.

Cytophotometric study of nuclear DNA content in scirrhous gastric carcinoma

We made a cytophotometric DNA analysis using 21 scirrhous gastric carcinomas (SGC), and compared the results with those of 12 undifferentiated type early gastric carcinomas (EGC) located in the gastric body. Nuclear DNA content of tumor cells was measured in the mucosa of SGC (SGCm), serosa of SGC (SGCs) and mucosa of EGC (EGCm). DNA distribution pattern was high ploid in 18 SGCm (86%), 16 SGCs (71%) and 4 EGCm (33%). Mean DNA content was 4.02c in SGCm, 3.91c in SGCs and 3.26c in EGCm. Percentage of tumor cells with a DNA content over 3c was 77.4% in SGCm, 69.1% in SGCs and 49.5% in EGCm. Statistically significant differences in these 3 factors were present between SGCm and EGCm, but absent between SGCm and SGCs. Furthermore, DNA distribution pattern was not different between the mucosa and serosa in 19 SGC (90%). The results suggest that most scirrhous gastric carcinomas are high ploid in origin and do not change their biologic behaviour throughout the tumor progression.

Assignment of CD38, the gene encoding human leukocyte antigen CD38 (ADP-ribosyl cyclase/cyclic ADP-ribose hydrolase), to chromosome 4p15

CD38 has been used as a phenotype marker of lymphocyte differentiation. Recently, we have demonstrated that cyclic ADP-ribose can be synthesized and hydrolyzed by CD38 and acts as a second messenger in insulin secretion from pancreatic beta-cells. We have mapped the CD38 gene to human chromosome 4p15 by fluorescence in situ hybridization.

In vitro induction of cytotoxic T lymphocytes against HTLV-I-infected T-cells from adult T-cell leukemia patients, asymptomatic HTLV-I carriers and seronegative healthy donors

We investigated an in vitro method to produce cytotoxic T lymphocytes (CTLs) against HTLV-I-infected T-cells using peripheral blood mononuclear cells (PBMC) of adult T-cell leukemia (ATL) patients, asymptomatic HTLV-I carriers (AC) and seronegative healthy donors. The PBMC were restimulated repeatedly for 4 weeks with HLA-matched HTLV-I-infected T-cells which had been pretreated at 56 degrees C for 30 min to inactivate infectious HTLV-I. The culture medium included 10-100 units/ml of recombinant lymphokines (rIL-1, rIL-2, rIL-4, rIL-6 and rIL-7) and 10% fetal calf serum in RPMI-1640 medium. The cytotoxic activity was measured against HLA-matched HTLV-I-infected T-cell lines after CD4+ or CD8+ cells were positively panned from the cultured PBMC. The PBMC of ATL, AC and healthy donors were able to produce either CD4+ or CD8+ CTLs against HTLV-I-related antigens (env, gag, p21x, p27rex and p40tax) as well as the antigen(s) of as-yet unknown specificity expressed on HTLV-I-infected T-cells. All the CTLs recognized the specific antigens in the context of either class I or class II HLA types. These results indicated that ATL patients, AC and healthy donors were immunocompetent to generate CTLs against HTLV-I-infected T-cells and probably against HTLV-I-transformed T-cells.

Alpha-melanocyte-stimulating hormone (MSH) inhibits insulin secretion in HIT-T 15 cells

alpha-Melanocyte-stimulating hormone (MSH) antagonizes the binding of interleukin-1 beta (IL-1) to its type I receptors on T cells. IL-1 modulates insulin secretion in the insulin-secreting tumor cell line, HIT-T 15 cells. In the present studies, we examined a hypothesis that alpha-MSH may modulate insulin secretion in HIT-T 15 cells. The addition of alpha-MSH over the concentrations of 10(-10) M inhibited insulin secretion for 4 h. In addition, the carboxyl-terminal tripeptide of alpha-MSH [alpha-MSH(11-13)], which is supposed to be an important sequence of alpha-MSH on its antipyretic effects, significantly inhibited insulin secretion at the concentration of 10(-9) M. In contrast, acetyl-[Nle4,D-Phe7] alpha-MSH(4-10)-amide (10(-11) to 10(-9) M) failed to inhibit insulin secretion. The maximal effect of alpha-MSH on insulin secretion was obtained at the concentration of 10(-9) M. The addition of alpha-MSH from 10(-11) to 10(-9) M significantly inhibited 7.5 mM glucose-stimulated insulin secretion at each period of 0-5, 5-15, and 15-30 min. Radioreceptor assay suggested that HIT-T 15 cells possess the specific binding sites for 125I-labeled alpha-MSH. The present studies indicated that alpha-MSH inhibits insulin secretion through the specific binding site in HIT-T 15 cells.

Successful treatment of a 93-year-old patient with hypoplastic acute monocytic leukemia using macrophage colony-stimulating factor

A 93-year-old patient with hypoplastic acute monocytic leukemia (AMoL) achieved a complete remission after macrophage colony-stimulating factor (M-CSF) therapy. Initially, the patient was treated with a low dose of cytarabine, but this treatment proved ineffective. M-CSF was administered for 14 days by drip intravenous infusion, 800 x 10(4) units per day. After a gradual decrease in the number of leukemic cells, a rapid increase in neutrophils was observed in the peripheral blood, and a bone marrow examination 22 days after discontinuation of M-CSF medication revealed a complete remission. These findings suggest that M-CSF may be useful in treating some elderly patients who have hypoplastic AMoL.

[An autopsied case of primary pulmonary hypertension complicated by hepatopulmonary syndrome]

A 57-year-old man, who had received a transfusion five years before, was admitted to our hospital complaining of worsening dyspnea on exertion. Cardiac catheterization was performed, and pulmonary hypertension was diagnosed. Liver dysfunction was also documented. We administered diuretics and observed his clinical course. Gradually worsening hypoxemia and radioisotope accumulation in the kidney following a lung perfusion scintigram suggested the existence of an intrapulmonary shunt. The patient died seven years later due to exacerbation of heart failure secondary to pulmonary infection. Autopsy revealed remarkable hypertensive pulmonary arteriopathy as well as abnormal dilation of precapillary pulmonary arterioles. Esophageal varices suggested portal hypertension. Marked hypoxemia and intrapulmonary vascular dilation suggest the contribution of an hepatopulmonary syndrome.

Multiple primary gastric and colorectal cancer in Japan

The features of multiple primary gastric and colorectal cancer (MPGCC) were investigated, using 447 patients with primary gastric cancer and 199 with colorectal cancer during 1981-1992. Thirteen of these patients were found to have adenocarcinoma in both the stomach and colorectum. The increase rate for MPGCC and colorectal cancer was higher than that of primary gastric cancer (p < 0.05). Of the 13 patients with MPGCC, 8 showed synchronous MPGCC, while 5 showed metachronous MPGCC. Five of the 8 patients with synchronous MPGCC showed either Stage I or II in both lesions of the stomach and colorectum, and all 5 patients with metachronous MPGCC showed Stage I or II in the lesion of the second primary cancer. Since patients with MPGCC are expected to have a relatively good prognosis, both a preoperative examination and postoperative follow-up will be needed in order not to overlook lesions of the stomach or colorectum in patients with MPGCC.

Lansoprazole inhibits oxygen-derived free radical production from neutrophils activated by Helicobacter pylori

We studied the influence of lansoprazole on Helicobacter pylori-elicited neutrophil activation, including the oxidative burst and infiltration of gastric mucosa, and confirmed whether radiolabeled lansoprazole is actually detected in gastric neutrophils. The oxidative burst of purified human neutrophils was measured by luminol-dependent chemiluminescence (ChL). [3H]Lansoprazole uptake sites in human gastric mucosa were observed by autoradiography. The magnitude of neutrophil infiltration of gastric mucosa was assessed by tissue myeloperoxidase (MPO) content. ChL assay indicated that oxygen-derived free radical production was increased twofold by adding H. pylori water extract, which was significantly inhibited by lansoprazole (10(-4) M). Gastric biopsy samples were obtained endoscopically from patients with H. pylori-positive gastritis. Autoradiographic examination revealed that the [3H]lansoprazole binding site was present in the cytoplasmic granules of infiltrated neutrophils. Tissue MPO content was significantly decreased after treatment with lansoprazole. These data suggest that lansoprazole binds directly to neutrophils, subsequently inhibiting neutrophil accumulation and release of toxic metabolites.

[A case of Mycobacterium fortuitum pulmonary disease in a healthy young woman successfully treated with ciprofloxacin and doxycycline]

A 22 year-old woman was admitted to our hospital complaining of subtle fever and productive cough. She did not smoke and had no underlying disease. Her chest radiograph showed infiltration in the right upper lung field. A diagnosis of Mycobacterium fortuitum pulmonary disease was made on the basis of isolation of M. fortuitum from repeated sputum cultures. On admission, we administered standard antimycobacterial agents, but found the M. fortuitum isolated in this case to be completely resistant to them. We then administered antibiotics including 600 mg of ciprofloxacin and 200 mg of doxycycline. The pneumonic findings on chest X-ray and her clinical symptoms gradually improved thereafter. The in vitro susceptibility tests confirmed the efficacy of ciprofloxacin and doxycycline. We concluded that these drugs contributed significantly to improve the disease.