Total knee arthroplasty covered with pedicle peroneal flap

Three cases of total knee arthroplasty (TKA) covered with pedicle peroneal flaps are reported. One peroneal flap was performed after TKA to correct post-TKA skin necrosis. Two peroneal flaps were performed before TKA to replace previous traumatic scar formed around the knee. All three TKAs were successful after the procedure. The thickness, elasticity, appearance, and durability of the peroneal flaps were more suitable for the skin around the knee than the gastrocnemius muscle flap or the local fasciocutaneous flap. As the peroneal flap was elevated as a pedicle flap, freedom of transfer was good, microanastomosis was not necessary, and no donor sites were needed from the contralateral limb. Scar tissue around the knee can be effectively replaced by the pedicle peroneal flap before TKA.

Noncompromised penicillin-resistant pneumococcal pneumonia CBA/J mouse model and comparative efficacies of antibiotics in this model

The present study confirms that CBA/J mice are susceptible to several clinical isolates of Streptococcus pneumoniae, including four of five penicillin-susceptible and all five penicillin-resistant strains tested, thus providing the first noncompromised animal model for penicillin-resistant S. pneumoniae pneumonia. In this model, doses of penicillin G of 0.6 mg/kg of body weight given six times at 1-h intervals produced effective pulmonary clearance of a penicillin-susceptible strain (penicillin G MIC, 0.015 microgram/ml), while doses of 40 mg/kg given six times at 1-h intervals were required to clear a penicillin-resistant strain (penicillin G MIC, 1 microgram/ml). Imipenem (MIC, 0.25 microgram/ml) was the most active antibiotic tested against the penicillin-resistant strain, with a calculated dose of 0.42 mg/kg given six times at 1-h intervals, resulting in a 2-log decrease in the number of pulmonary bacteria. Comparable effects were seen with vancomycin (MIC, 0.5 microgram/ml), cefotaxime (MIC, 0.5 microgram/ml), and penicillin G at doses of 3.3, 5.5, and 31.0 mg/kg given six times at 1-h intervals, respectively. The pharmacokinetic profile of vancomycin in infected lungs was superior to those of the other antibiotics, especially in regard to the elimination half-life (215.4 min for vancomycin versus 15.0, 14.5, and 14.5 min for penicillin G, cefotaxime, and imipenem, respectively). Both imipenem and vancomycin allowed 90% survival when 40-mg/kg doses were administered twice a day beginning 5 days after infection. Survival rates with penicillin G (160-mg/kg doses) and cefotaxime (40-mg/kg doses) were 40 and 30%, respectively, while no saline-treated mice survived. The present study shows that the CBA/J mouse pneumonia model may be useful for evaluating antibiotic efficacies against penicillin-resistant pneumococcal pneumonia in immunocompetent individuals. Our data suggest that imipenem and vancomycin may be the most active agents against penicillin-resistant S. pneumoniae pneumonia.

[Comparative study of mRNA expression of E-cadherin and collagenase IV in early and advanced cancers]

During the process of invasion, tumor cells must detach from the primary neoplasm and degrade host stroma. E-cadherin is responsible for the cell-cell adhesion and collagenase IV is the one of the matrix metalloproteinases. We determined whether the levels of mRNA for E-cadherin and collagenase IV were differently expressed within 12 cases of early and 13 cases of advanced gastric cancers using a rapid calorimetric in situ hybridization assay for mRNA. In 6 of 12 early cancers, we found a decreased expression of E-cadherin mRNA in the invasion edge compared to the main tumor. In advanced gastric cancers, 3 out of 13 cancers also exhibited this finding. Higher expression of the collagenase IV at the invasion edge of the tumor compared to the main tumor was observed in half of the early and advanced gastric cancer cases. Inverse expression levels of E-cadherin and collagenase IV mRNA were observed in 6 of 12 early cancers. However, only one of 13 advanced cancer cases expressed the same finding.

[Hepatocellular carcinoma following interferon therapy]

We experienced six patients with resected hepatocellular carcinoma (HCC) following interferon (IFN) therapy. Hepatitis virus C-RNA in polymerase chain reaction was positive in all patients prior to the IFN therapy. HCV-RNA became negative in two patients following IFN therapy, and was re-positive at the time of detection of HCC. In histological studies prior to the IFN therapy, pre-cirrhosis was diagnosed in four out of six patients and chronic active hepatitis 2B (CAH2B) in one according to the Europian classification. In non-cancerous portion of the liver, cirrhosis developed in five patients, and CAH2B in one. There was no significant correlation among the interval of HCC detection following IFN therapy, tumor size, tumor location, and histological findings. Patients should be carefully followed up by serum alpha fetoprotein levels or ultrasonography of the liver during and following IFN therapy.

Temperature dependence of structure parameters in natural magnetite: single crystal X-ray studies from 126 to 773 K

Structural parameters and their thermal changes in natural magnetite, Fe3O4, have been studied using the single-crystal X-ray diffraction method in the temperature range 126–773 K. The cell dimensions, oxygen coordinate and atomic mean square displacements (m.s.d.'s) reversibly change as a function of temperature. The coordinate of oxygen remains almost constant at x = 0.2549 (1) below ~600 K, but increases with increasing temperature above this temperature. This characteristic behavior of the oxygen coordinate with temperature indicates that the cation disordering over the tetrahedral (A) and octahedral (B) cation sites occurs above 600 K. All atomic m.s.d.'s increase monotonously with temperature rise. The m.s.d.'s of the B atom show a unique temperature dependence. At lower temperatures the B atom prefers to vibrate along [111], but this preference is reduced with a temperature rise up to 630 K, above which the m.s.d. normal to [111] becomes dominant.

Insulin-like growth factor-binding proteins (IGFBPs) and their regulatory dynamics

The IGFBPs are a family of homologous proteins that have co-evolved with the IGFs and that confer upon the IGF regulatory system both functional and tissue specificity. IGFBPs are not merely carrier proteins for IGFs, but hold a central position in IGF ligand-receptor interactions through influences on both the bioavailability and distribution of IGFs in the extracellular environment. In addition, IGFBPs appear to have intrinsic biological activity independent of IGFs. The current status of research on IGFBPs is reviewed herein. Following a brief introduction to the entire IGF/IGFBP system, separate sections for each of the six cloned mammalian IGFBPs, the most extensive for IGFBP3, cover selected topics that emphasize the dynamics of IGFBPs--that is, their regulation in cells, their functionally important post-translational modifications, and their interactions in the cellular microenvironment--and how these dynamics influence physiological function.

A randomized cross-over trial of granisetron and dexamethasone versus granisetron alone: the role of dexamethasone on day 1 in the control of cisplatin-induced delayed emesis

We studied the role of dexamethasone (DEX) administered on day 1 in controlling cisplatin-induced delayed emesis. Forty patients were randomly allocated to receive either granisetron (GRN) and DEX on day 1, or the same dose of GRN alone. On days 2-5, all the patients received metoclopramide and DEX. They were crossed over to the other antiemetic regimen with their second course of chemotherapy. Thirty-one patients were evaluable for efficacy. The mean visual analogue scale scores for nausea on days 1 and 2 were 9.1 and 18.8 mm for GRN and DEX, and 16.3 and 28.5 mm for GRN alone, respectively (P<0.05 on day 2). The mean numbers of emetic episodes on days 1-3 were 0.036, 0.46 and 0.36 for GRN and DEX, and 0.39, 0.89 and 0.57 for GRN alone, respectively (P<0.01 on day 1). Hiccups and restlessness were noted in 38% and 33% of cycles, respectively. Addition of DEX to GRN on day 1 thus enhanced the control of delayed emesis.

Protein-protein interactions between the Escherichia coli single-stranded DNA-binding protein and exonuclease I

It was demonstrated previously that a deoxyribophosphodiesterase (dRpase) activity is associated with the DNA repair enzyme exonuclease I, and that this activity is stimulated by the addition of the E. coli single-stranded DNA-binding protein (Ssb). This activity catalyzes the release of deoxyribose-phosphate groups at apurinic/apyrimidinic (AP) sites in the DNA that have been cleared by the action of an AP endonuclease. We have now used the yeast two-hybrid system to demonstrate that a protein-protein interaction occurs between exonuclease I and Ssb. When the E. coli ssb gene was fused in frame to the DNA-activating domain of the GAL4 transcriptional activator and the exonuclease I gene was fused in frame to the DNA-binding domain, a functional GAL4 transcriptional activator was produced as determined by growth of yeast on selective medium and the measurement of beta-galactosidase activity. We have also demonstrated that Ssb can stimulate the dRpase activity of exonuclease I using double-stranded bacteriophage M13 DNA containing several strand interruptions at incised AP sites. These results suggest that Ssb may be required for efficient base-excision repair in bacteria.

Effects of interferon-alpha, beta, and gamma on the function of differentiated leukemic HL-60 cells induced by 1,25-dihydroxyvitamin D3

The differentiation of HL-60, a human leukemic cell line, into monocyte-like cells (D3-HL-60 cells) is induced by 1,25-dihydroxyvitamin D3 (D3). We examined the effects of interferon (IFN) treatment of D3-HL-60 cells on the expression of cell surface antigens, the phagocytic activity for fluorescent beads, production of oxygen radicals, and intracellular growth of Legionella pneumophila. Activation of D3-HL-60 cells with IFN-gamma, Beta, and alpha for 24 h significantly increased expression of CD16, CD36, CD71, and HLA-DR antigens. IFN-gamma markedly enhanced the phagocytic activity of beads in D3-HL-60 cells. There was no significant difference in phagocytic activity between cells exposed to IFN-alpha or beta and untreated D3-HL-60 cells. IFN-alpha, beta, and gamma enhanced production of oxygen radicals, including superoxide, by D3-HL-60 cells. Superoxide production was enhanced to the greatest degree by IFN-gamma, followed by IFN-beta and then IFN-gamma. Intracellular growth of L. pneumophila in D3-HL-60 cells was inhibited by interferons (IFN-gamma > beta > gamma). Similar results were obtained in human mononuclear cells. These data indicate that interferons can act as biologic response modifiers not only in human mononuclear cells but also in differentiated leukemic cells. Our results may have implications for the development of differentiation therapy for treatment of leukemia.

Concentrations of vascular endothelial growth factor in the sera of normal controls and cancer patients

Vascular endothelial growth factor (VEGF) is known to play crucial roles in tumor angiogenesis. We have investigated the circulating level of VEGF in sera from cancer patients as well as from healthy normal controls using a sensitive enzymatic immunoassay. Immunoreactive VEGF proteins were detectable in normal sera, and the cutoff level was determined to be 180 pg/ml. In examined patients with all types of cancer, including breast, gastrointestinal, hepatobiliary, and lung cancer, an aberrant increase in the circulating level of VEGF was detected. For example, in 137 primary breast cancer patients, 12 (8.8%) showed an aberrant increase in VEGF levels. This aberrant expression of VEGF in sera was significantly associated with the progression of the disease, and with VEGF protein expression in tumor tissues. In addition, a Western blot analysis confirmed the presence of the VEGF165 form in sera from a patient with recurrent breast cancer. It was concluded that VEGF was detectable in normal sera, and its level was increased in some populations of cancer patients. A positive angiogenesis regulator, VEGF might function as an endocrine growth factor, particularly for solid tumors.

Dynamic pulmonary SPECT of xenon-133 gas washout

A triple-detector SPECT data acquisition mode of "continuous repetitive rotation acquisition" was applied to dynamic pulmonary SPECT with 133Xe gas.

METHODS

Subjects included 7 healthy volunteers, 22 patients with a space-occupying mass lesion, 22 with obstructive lung disease and 10 with restrictive lung disease. Following rebreathing of 133Xe, equilibrium and washout SPECT images during spontaneous breathing were acquired every 30 sec for 5-7 min. Regional 133Xe washout was assessed by the real half-time (T1/2) and mean transit time (MTT) images.

RESULTS

SPECT and MTT images represented a gravity-induced gradient of ventilation in normal lungs and detailed the distribution of heterogeneous 133Xe washout in patient's lungs with or without abnormalities on chest x-ray CT. The T1/2 (111.4 +/- 26.4 sec) and its coefficient of variation (0.36 +/- 0.13) in obstructive lung diseases were significantly different from those (56.8 +/- 3.9 sec and 0.16 +/- 0.15) in restrictive lung diseases (p < 0.001, p < 0.05, respectively). Comparison of SPECT and planar studies assessed in 19 patients revealed superiority of SPECT in detecting ventilatory abnormalities and a high correlation of T1/2 between the two studies ( r= 0.977, p < 0.001).

CONCLUSION

This modality has excellent potential for elucidating the distribution and nature of ventilatory abnormalities.

[Inhibitory effect of a thromboxane A2 receptor antagonist, AA-2414, on active oxygen production by alveolar macrophages and polymorphonuclear leukocytes in guinea pigs]

We examined the effect of a thromboxane A2 receptor antagonist, AA-2414, on active oxygen production by guinea pig alveolar macrophages and peritoneal polymorphonuclear leukocytes and the xanthine-xanthine oxidase (X-XOD) system. The production of active oxygen was detected by luminol-dependent chemiluminescence (CL). AA-2414 inhibited CL of alveolar macrophages induced by zymosan, platelet activating factor (PAF) and phorbol myristate acetate (PMA) with IC50 values of 25, 8.8 and 5.6 microMs, respectively. In addition, AA-2414 reduced CL of polymorphonuclear leukocytes induced by PMA (IC50: 15 microMs). On the other hand, AA-2414 had no inhibitory effect on CL in the X-XOD system. Superoxide dismutase (SOD) reduced CL in all three of these systems. These results suggest that the active oxygen species involved in these systems is mainly the superoxide anion (O2-) and that the inhibitory action of AA-2414 on CL in guinea pig leukocytes is dependent on inhibiting the production of O2- in guinea pig leukocytes.

Use of endosonographic evaluation of colorectal tumor depth in determining the appropriateness of endoscopic mucosal resection

OBJECTIVES

To determine the efficacy with which endoscopic ultrasonography (EUS) is able to differentiate between mucosal and submucosal invasion for application of endoscopic resection.

METHODS

We prospectively analyzed 60 patients who were diagnosed with early cancer by conventional EUS with regard to the accuracy of mucosal neoplasia as a function of gender, age, location, size, endoscopic configuration, histological diagnosis, and method of resection.

RESULTS

Forty lesions interpreted as mucosal by EUS were shown histologically to include 32 lesions in the mucosa and eight in the submucosa or deeper, whereas 20 tumors interpreted as invasive cancer included six lesions in the mucosa and 14 in the submucosa or deeper. The accuracy of mucosal neoplasia (AMN) detection was 77% (true-positive and true-negative mucosal neoplasias divided by all lesions). Assessment of pure cancers without adenomatous components produced a significantly lower AMN (59%, p = 0.03) than the assessment of pure adenomas (95%) or cancers in adenomas (87%). However, there were no significant differences in the EUS assessment of intramucosal neoplasia as a function of sex, age, endoscopic configuration, size, location, or treatment.

CONCLUSIONS

We conclude that conventional EUS interpretation alone cannot determine the appropriate treatment for early colorectal cancer.

Analysis of function, specificity and T cell receptor expression of cloned mucosal T cell lines in Crohn's disease

Monoclonal populations of mucosal T cells were established from the earliest visible lesions in eight patients with well defined Crohn's disease. The FACS phenotype of all the mucosal derived clones to date are TCR alpha/beta+, CD3+, CD4+, and CD45RO+ memory cells. TCR variable region Beta chain analysis revealed predominantly V beta families 1, 2, 5.1, 5.2, 6, 7 and 8, with V beta family analysis supporting antigen expansion in the diseased mucosa. Putative autoreactivity was evaluated by stimulating individual clones with a battery of antigens and determining proliferation and IL-2 production by thymidine incorporation at 72 h. Antigens tested included crude Crohn's diseased (CD) colon and small bowel homogenates, CD brush border preparations, crude CD colon and small bowel mucin, and purified CD small bowel mucin. Controls included clone, APC, tetanus toxoid and either PHA or Staphylococcus enterotoxin B. A total of 200 clones were studied with 29.5% or 59 clones demonstrating proliferation and/or IL-2 production. T cell receptor V beta gene usage evaluated in a small number of reactive clones correlated with the expanded patient families. Seven of the fifteen represented families revealed diverse T cell receptor gene use and no disease overlap.

Purification and some properties of an endo-1,4-beta-D-mannanase from a marine mollusc, Littorina brevicula

An endo-1,4-beta-D-mannanase (EC 3.2.1.78) was purified from viscera of a marine mollusc Littorina brevicula. The purified enzyme, with a molecular weight of 42,000, was homogeneous by SDS-PAGE. The amino-terminal sequence starting with Gly was analyzed up to the 30th amino acid. The enzyme was stable from pH about 4.0 to about 9.0 and had its maximum activity at pH about 6.5. The purified enzyme produced M2, M3, M4, and M5 from Codium beta-1,4-mannan. The enzyme activity was greatly inhibited by Ag+, HG2+, Cu2+, and N-bromosuccinimide at 1 mM concentration.

[Attempt of helical CT densitometry for assessing regional pulmonary ventilation]

Pulmonary dynamic CT densitometry during steady-state breathing was recorded and analyzed using helical CT scan in 14 patients with obstructive disorders involving small and large airways, and 2 with restrictive lung disease. The data set of 7-second, continuous helical scan at constant table position were reconstructed as 35 one-second temporarily overlapping images at 0.2- second intervals over 2-3 respiratory cycles, and regional CT densitometry was displayed. Normal lungs (5 volunteers) showed a regular sinusoidal curve, and maximal lung density change (LDC) was greater independent lungs than in independent lungs, with an average difference of 29.5 HU, indicating the gravitational effect In contrast, a regular sinusoidal curve was not shown in obstructive disorders, and a significant reduction in maximal LDC (33.7 +/- 22.6 HU) compared with the normal lungs (60.8 +/- 25.9 HU) (P < 0.001) was indicated. In contrast, no marked reduction in maximal LDC (53.7 +/- 28.6 HU) was shown in restrictive disorders. This method is fast and easy, and appears useful for the detection of ventilation abnormalities in obstructive lung disorders.

Gliomatosis cerebri: a case report

Gliomatosis cerebri is a rare disease that thus far was usually diagnosed at the time of autopsy. In this communication we report the case of a young woman with gliomatosis cerebri. Diagnosis was established on the basis of characteristic imaging findings and typical histopathological features of surgical specimens obtained by craniotomy.

Ammonia response to exercise in patients with congestive heart failure

OBJECTIVE

To assess energy depletion in skeletal muscle in patients with congestive heart failure by measuring blood purine metabolites during exercise and, at the same time, determine the implications of the ammonia response to exercise in these patients.

SETTING

Tottori University Hospital, Yonago, Japan.

PATIENTS

49 heart failure patients (New York Heart Association (NYHA) grades I-III) and 16 normal subjects.

MAIN OUTCOME MEASURES

Blood lactate, ammonia, and hypoxanthine levels were measured during exercise with expired gas analysis.

RESULTS

In normal exercising subjects as well as in each heart failure subgroup, the ammonia threshold was significantly higher than both the lactate threshold [control: 21.8 (SD 5.3) v 17.4 (3.3) ml/kg/min; NYHA class I: 18.9 (3.8) v 15.5 (2.6); class II: 14.8 (2.5) v 12.7 (2.4); class III: 13.5 (2.6) v 11.8 (2.5)] and the ventilatory threshold (P < 0.01). The difference between the ammonia and lactate thresholds was noted in all normal subjects and in all heart failure patients. The ammonia threshold, however, was significantly lower in heart failure patients than in normal subjects and it decreased with increasing NYHA class (P < 0.01). Maximum ammonia levels were lower in the heart failure group and decreased further with higher NYHA classifications [control: 198 (52) mg/dl; NYHA class I: 170 (74); class II: 134 (58); class III: 72 (15); P < 0.01]. There were significant correlations between maximum ammonia values and maximum lactate, oxygen consumption, and hypoxanthine levels (r = 0.74, 0.48, and 0.87, respectively; P < 0.001).

CONCLUSIONS

The ammonia threshold may reflect the onset of ATP depletion in exercising skeletal muscles, as opposed to the onset of anaerobic respiration. It seems therefore that energy depletion in skeletal muscles during exercise occurs after attaining the anaerobic threshold. Both aerobic and anaerobic capacities of skeletal muscle are reduced in patients with congestive heart failure.

Subclinical depressive symptoms in HIV are related to avoidance coping responses: a comparison with end-stage renal failure and breast cancer

We examined the relationship between coping responses and mood states among three samples of patients with human immunodeficiency virus (HIV) infection (n=26), end-stage renal failure (n=98), and breast cancer (n= 60). Avoidance scores differed significantly across the groups, being highest in those with HIV infection. The avoidance scores were significantly and positively correlated with depression scores. However, patients with HIV infection did not fulfill the diagnostic criteria for major depression. Although patients with HIV infection may have minor psychiatric symptoms, results suggest that the symptoms are not strong enough to warrant a psychiatric diagnosis of mood disorder. It might be clinically important to attend to avoidance behaviors and thoughts which may develop into the manifestation of depression.

The impact of thrombolytic therapy on arterial and graft occlusions: a critical analysis

BACKGROUND

The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior to vascular reconstructions requires further refinement before firm conclusions can be made.

STUDY DESIGN

A retrospective review of 55 patients undergoing 81 lytic treatments with high dose urokinase from February 1989 to February 1993 was performed. The cases were divided into three groups: Group I: successful thrombolysis with residual defects followed by surgical reconstruction or percutaneous transluminal angioplasty (PTA); Group II: successful thrombolysis alone; and Group III: failure of thrombolysis requiring reconstruction or leading to amputation. No effort was made to analyze the particular type of reconstruction. Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months).

RESULTS

One, two, and three year patency rates were 47%, 24%, and 8% for Group I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Group III respectively. The one, two and three year limb salvage rates were 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 48%, 37%, and 37% for Group III respectively. Forty-one complications occurred in 35 of the 81 (43%) lytic treatments.

CONCLUSIONS

Intraarterial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower extremity arterial and synthetic graft occlusions especially in patients with multiple prior vascular reconstructions. Unsuccessful thrombolysis results in a poor outcome despite surgical reconstruction in the majority of cases.

[T cell receptor V beta repertoire in Crohn's disease]

Although the pathogenesis of Crohn's disease remains yet clarified, impaired immunologic stimuli in intestinal mucosa may play an important role in the disease. T cell receptor repertoire, which recognizes antigens in conjunction with class II MHC molecules, reflects characteristics of antigenic stimuli related to the disease. In lamina propria lymphocytes in patients with Crohn's disease, skewing in T cell receptor V beta repertoire was confirmed in T cell clones generated from early aphtous lesion. Most of them showed oligoclonal expansion in some subsets of V beta. These results suggest that lamina propria lymphocytes were selectively stimulated by the local antigens closely related to the pathogenesis of the disease.