[Reoperation for complications of mitral valve surgery]

Among the early postoperative complications of mitral valve surgery. Mitral Regurgitation (MR) is one of the most dangerous complications, which has to be diagnosed and to be treated as early as possible. Four reoperations-two of which are of paraprosthetic regurgitation, and two of recurrent MR after mitral valve plasty-are reported. Their clinical courses and transesophageal echocardiographic findings are shown. And the differences their MR has when it is compared with the physiologic MR of the prosthetic valve and with the acceptable MR after mitral valve plasty are described.

[Long-term prognosis of the interferon-treated patients with chronic hepatitis C: compared with the natural course]

To evaluate the prognosis of the interferon (IFN)-treated patients with chronic hepatitis C (CH (C)), the clinical course and outcome of patients with CH (C) who were administered IFN more than 5 years before was compared with the natural course of untreated patients with CH (C) who were followed-up for 5 years. Good responders to IFN therapy showed normalized serum ALT level thereafter except one patient who were positive for serum HCV-RNA and had relapse of hepatitis. Histological improvements were observed in good responders. In groups of poor responders and non-responders, the fluctuation of serum ALT and histological changes after IFN therapy seemed to be similar to the natural course. Several problems on the prognosis are discussed.

[Bladder carcinoma producing granulocyte colony stimulating factor (G-CSF). A case report]

A 69-year-old woman was admitted to the hospital complaining of general fatigue and lower abdominal pain. She had undergone total cystectomy because of invasive recurrent bladder carcinoma three months ago. Histopathological diagnosis was transitional cell carcinoma (TCC) grade 3 and squamous cell carcinoma (SCC), pT3a. A goose egg-sized painful mass was noticed at the lower abdominal region. A CT scan revealed an intrapelvic fist-sized mass and suggested tumor recurrence with ileus caused by intestinal invasion. The laboratory examination showed remarkable leukocytosis of 79,700/mm3 in the peripheral blood and serum analysis revealed high value of granulocyte colony stimulating factor (G-CSF), 240 pg/ml (normal: less than 30 pg/ml). In spite of active treatment, the patient died of cachexia about a month after detection of the leukocytosis. The autopsy showed that the recurrent tumor had positive immunohistochemical staining for G-CSF, and the bone marrow had reactive proliferation mainly by granulocytes. From these findings, this case was diagnosed as bladder carcinoma producting G-CSF. G-CSF producting tumor of the bladder is very rare. This was the 8th case in Japanese literatures. The previous reports were reviewed and discussed.

Inhibitory activity on DNA gyrase and intracellular accumulation of quinolones: structure-activity relationship of Q-35 analogs

Q-35, 1-cyclopropyl-6-fluoro-1,4-dihydro-8-methoxy-7-(3- methylaminopiperidine-1-yl)-4-oxyquinoline-3-carboxylic acid, has excellent activity against gram-positive bacteria and inhibits S. aureus gyrase at concentrations more than 10-fold lower than those of other quinolones. In this paper, the effect of the C-7 and C-8 substituents of Q-35 on the inhibitory activity of gyrase purified from S. aureus, M. luteus, E. coli, and P. aeruginosa are described. In addition, intracellular accumulation of Q-35 was examined. The 50% inhibitory concentrations (IC50) of Q-35, 8-fluoro- Q-35, and 8-hydro-Q-35 on DNA gyrase purified from S. aureus were 2.5, 7.8, and 68 micrograms/ml, respectively. The IC50 on gyrase from P. aeruginosa were 11, 5.2, and 17 micrograms/ml, respectively. It is concluded that the introduction of a methoxy group into the 8 position of the quinolone leads to greater antibacterial activity against gram-positive bacteria. The concentrations of Q-35 which accumulated in S. aureus and E. coli were almost equal to ciprofloxacin, but in P. aeruginosa, Q-35 was lower than ciprofloxacin.

[A case of spontaneous rupture of renal cell carcinoma]

A case of renal cell carcinoma causing spontaneous rupture is reported. A 45-year-old male patient complaining of right flank pain without any trauma was referred to our hospital. Computerized tomography (CT) and angiography demonstrated extracapsular hemorrhage with renal cell carcinoma and right radical nephrectomy was performed. Hemorrhage was recognized in the peritoneal and retroperitoneal space. Pathological diagnosis was renal cell carcinoma. Thirteen cases of spontaneous rupture of renal cell carcinoma in the Japanese literature are reviewed. CT proved to be the most valuable imaging for differentiation. There was intraperitoneal bleeding in 3 of the 13 cases.

[The development of a new central monitoring system for the operation room]

We developed a practically new central patient monitoring system for the operating room based on a system which had been developed in 1982. Since we introduced this system on May 19, 1992, we have utilized the system in more than 2,000 anesthesia cases. This system has been operating smoothly and accepted well by not only anesthesiologists but also surgeons and nurses. This system is easy to operate, and works automatically, contributing to the early detection of abnormalities in patient's condition. By introducing this system, the anesthesiologists have succeeded in controlling the patient during the operation more elaborately and effectively than before. Automated anesthesia recorder has reduced anesthesiologist's burden of the manual recording.

[Randomized controlled study of sequential methotrexate and 5-fluorouracil therapy with or without 5'-deoxy-5-fluorouridine against advanced gastrointestinal cancer. Hirosaki Cooperative Study Group for Cancer Chemotherapy]

Seventy-five patients with gastrointestinal cancer were entered in this study. The number of eligible cases were 38 in the group treated with sequential methotrexate (MTX)/5-fluorouracil (5-FU) with 5'-deoxy-5-fluorouridine (5'-DFUR) (group A) and 34 in the group without 5'-DFUR (group B). The treatment schedules were as follows: MTX/100 mg/m2 was given intravenously (i.v.) followed by 5-FU 600 mg/m2 i.v. 2 hours later and leucovorin 15 mg/body i.v. 8 and 20 hours later. This cycle was repeated once a week. In group A, 5'-DFUR 1,200 mg/body/day was given orally 5 consecutive days per week. Three of 35 cases in group A showed PR, while no case showed PR in group B. Median survival time was 5.0 months in group A and 5.3 months in group B, respectively. Gastrointestinal toxicity was commonly observed, and diarrhea was more frequent in group A (p < 0.05).

[Clinical study of intraurethral stent for patients with benign prostatic hypertrophy with 1-year follow up]

Seven consecutive patients with acute retention due to benign prostatic hyperplasia, were treated by insertion of an intraurethral stent using endoscopy under mucosal anesthesia. The patients were between 68 and 86 years old with an average age of 79.7 years. During the 1-year follow-up period all patients had satisfactory voiding. No complication or renal dysfunction were found. This device is a good alternative to an indwelling catheter in patients awaiting prostatic surgery and also in those who are either unfit or unwilling to undergo prostatectomy.

Ca2+/calmodulin-dependent protein kinase V: tissue distribution and immunohistochemical localization in rat brain

Polyclonal antibody against Ca2+/calmodulin-dependent protein kinase V (CaM kinase V) was prepared from guinea pigs immunized with synthetic polypeptide, based on the partial amino acid sequence of the rat brain enzyme. Immunoblot analysis of purified CaM kinase V revealed two immunoreactive bands with a molecular mass of 41 kDa and minor 40 kDa, respectively. Tissue distribution of CaM kinase V and immunohistochemical localization in rat brain were also investigated. Immunoblotting revealed the presence of immunoreactive proteins with the same molecular mass of 40 and 41 kDa, in the cerebrum, cerebellum, brain stem, pituitary gland, lung, adrenal gland, spleen, liver, colon, heart, stomach, ovary, spinal cord, and thymus. Immunohistochemistry revealed strong staining in the neuronal somata and weak staining in the nuclei. Densely stained regions included the cerebral cortex, the hippocampal formation, the caudatoputamen, the globus pallidus, the hypothalamus, the substantia nigra, the medial geniculate body, the olfactory bulb, the cerebellar cortex and the choroid plexus. CaM kinase V revealed different substrate specificity compared with CaM kinase II. These results lead to the notion that CaM kinase V may exist in 40- and 41-kDa isoforms, is widely distributed in various tissues, and may play an important role in the control of a wide variety of calcium regulated processes in the respective tissues.

Ca2+/calmodulin-dependent protein kinase V and I may form a family of isoforms

We reported that polyclonal antibody against Ca2+/calmodulin-dependent protein kinase V (CaM kinase V) reacted to two proteins of rat cerebrum with a molecular mass of 40 and 41 kDa. This antibody revealed the immunoreactivity with CaM kinase I expressed in E. coli (recombinant CaM kinase I), of which molecular mass was 40 kDa, whereas 41 kDa mainly with purified CaM kinase V. The immunoreactive bands of recombinant CaM kinase I and CaM kinase V did not shift by phosphorylation or dephosphorylation. These results suggest that CaM kinase V and CaM kinase I may form a family of isoforms.

Cell compositions of coronary and aortic atherosclerotic lesions in WHHL rabbits differ. An immunohistochemical study

This study investigated whether coronary atherosclerosis was different from aortic atherosclerosis in Watanabe heritable hyperlipidemic rabbits. Atherosclerotic lesions were immunohistochemically stained by using a monoclonal antibody for rabbit macrophages (RAM-11) and a monoclonal antibody for muscle actin (HHF35) and were also subjected to conventional staining. The areas of the major lesional components, ie, macrophages, smooth muscle cells, collagen fibers, and extracellular lipid deposits, were measured with a color image analyzer. The percent macrophage area in coronary lesions was significantly lower compared with aortic lesions at all stages (early fatty streak, transitional, and advanced), while the percent smooth muscle cell area and collagen area were significantly higher in early fatty streak lesions of the coronary arteries. In addition, the macrophage area/smooth muscle cell area ratio was significantly lower in coronary lesions compared with aortic lesions at all stages. In conclusion, coronary atherosclerosis had a small number of macrophages and was rich in smooth muscle cells, whereas aortic atherosclerosis showed the opposite features. These results suggested that the role of macrophages and smooth muscle cells in the initiation and/or progression of coronary atherosclerosis differs from the role of these cells in aortic atherosclerosis.

Immunoelectron microscopic study of the GH cell in the anterior pituitary gland of normal human fetus

BACKGROUND

Ultrastructural studies of growth hormone-producing cells (GH cells) in the anterior pituitary gland have been reported using several experimental animals. However, no attempt has yet been made to identify the ultrastructural heterogeneity of the GH cells within the human anterior pituitary gland. To this end, we employed immunogold electron microscopy to investigate the ultrastructural characteristics of GH cells in relation to gestational age in normal human fetuses.

MATERIALS

Based on ultrastructural characteristics, three distinct types of GH cells were identified by immunogold electron microscopy in the anterior pituitary glands of 34 normal human fetal pituitary glands. The age of the tissue samples ranged from 8 to 34 weeks.

RESULTS

The Type-I GH cell is a small, round cell with a narrow cytoplasm containing a few small secretory granules (268 nm in mean diameter). The GH cells designated Type-II are polygonal and contain medium-sized secretory granules (347 nm), profiles of rough endoplasmic reticulum (RER) arranged in parallel lamellae, and a Golgi complex which is frequently encountered but only in this cell type. The Type-III GH cell is polygonal, large, and contains numerous large spherical-shaped secretory granules (404 nm). The Type-I was the predominant cell type until about 20 weeks of gestation; its incidence decreased thereafter. In contrast, the Type-II and Type-III cells increased in number starting at 20 weeks of gestational age.

CONCLUSION

From these results, we suggest that Type-I is the most immature type of GH cell, Type-III the most mature, and the Type-II is intermediate in development. The marked difference in the incidence of each GH cell type between the first and second half of gestation appears to be a reflection of the development of the hypothalamic regulation of the anterior pituitary gland, which is reported to be established at around 20 weeks of gestation.

[Sequential methotrexate/5-fluorouracil therapy with 5'-deoxy-5-fluorouridine against advanced gastric cancer: comparison between bolus injection and drip infusion of 5-fluorouracil administration. Hirosaki Cooperative Study Group for Cancer Chemotherapy]

Forty-two patients with gastric cancer were entered in this study. Forty-one of them were eligible and administered sequential methotrexate (MTX)/5-fluorouracil (5-FU) with 5'-deoxy-5-fluorouridine (5'-DFUR). 5-FU was administered intravenously by drip infusion for 2 hours in 22 cases (group A), and was infused by bolus injection in 19 cases (group B). The treatment schedules were as follows: MTX 100 mg/m2 was given intravenously (i.v.) followed by 5-FU 600 mg/m2 i.v. 2 hours later and leucovorin 15 mg/body i.v. 8 and 20 hours later. This cycle was repeated once a week. 5'-DFUR 1,200 mg/body/day was given orally on 5 consecutive days per week. Three of 20 cases (15%) in group A showed PR, while 5 of 15 cases (33%) in group B showed PR. Median survival time was 2.8 months in group A and 3.7 months in group B. There was, however, no statistical difference. Gastrointestinal toxicity was commonly observed. Leukocytopenia was more severe in group B. Alopecia was more frequently observed in group B (p < 0.025). These results suggested bolus injection of 5-FU was a promising way of administration in sequential MTX/5-FU therapy.

Substrate specificity of Streptomyces beta-xylanase toward glucoxylan

To discover the specificity of Streptomyces beta-xylanase toward xylan having glucose stubs, glucoxylan was prepared by the hydrogenation of cotton-seed cake glucuronoxylan. The glucoxylan was hydrolyzed by the beta-xylanase of Streptomyces olivaceoviridis E-86, and three kinds of glucoxylo-oligosaccharides were isolated from the hydrolysate by chromatographies on a charcoal column, preparative paper partition, and a Toyopearl HW-40F column. The isolated oligosaccharides had the structures of 2(3)-alpha-glucopyranosylxylotriose, 2(3)-alpha-(4-O-methyl-glucopyranosyl)xylotriose and 2(4)-alpha-glucopyranosylxylotetraose. From the structure of the above oligosaccharides and the results of our previous studies, we suggest that the specificity of Streptomyces beta-xylanase toward glucose stubs is the same as that toward glucuronic acid stubs, but differs considerably from that toward arabinose stubs.

Tricuspid valve myxoma in a child with coronary artery occlusion and aneurysms

The case of a 13-year-old boy with a tricuspid valve myxoma and coronary artery occlusion and aneurysms suspected to be caused by Kawasaki's disease is presented. Simultaneous extirpation of the myxoma and coronary artery bypass grafting to the left anterior descending artery using the left internal mammary artery was performed. His postoperative course was satisfactory. Coronary artery bypass grafting in a child is also discussed.

A case of gastrointestinal bleeding associated with calcific aortic stenosis

Gastrointestinal bleeding is not rare in patients with calcific aortic stenosis (AS) in Western countries, which has suggested an association between the two conditions. However, there has been no previous report of this association in Japan. In this report we describe a patient with AS who had recurrent gastrointestinal bleeding. An 84-year-old female who had been followed for severe AS presented with recurrent rectal bleeding, but the site of bleeding could not be detected despite various examinations, including endoscopy. She died of progressive heart failure during hospitalization. Postmortem examination disclosed severe left ventricular hypertrophy with calcific aortic stenosis. Microscopically, angiodysplastic lesions were observed in the submucosa throughout the gastrointestinal tract.

Protective effects of gabexate mesilate on acute pancreatitis induced by tacrolimus (FK-506) in rats in which the pancreas was stimulated by caerulein

We investigated the acute effects of the immunosuppressive agent, tacrolimus (FK-506), on the exocrine pancreas, in rats with or without stimulation of the pancreas, and evaluated the protective effects exerted by gabexate mesilate (FOY). While an intravenous injection of FK-506 did not change serum amylase levels during the 5-h observation period, this agent increased pancreatic amylase and protein content, and decreased the content of pancreatic DNA. Histologically, we observed intra-acinar vacuolization and individual cell necrosis. When the pancreas was stimulated by two intraperitoneal injections of caerulein (5 micrograms/kg) at 1-h intervals, however, which treatment did not induce any evident pancreatic change, FK-506 significantly increased serum amylase, pancreatic wet weight, and pancreatic amylase and protein, and decreased pancreatic DNA. Histologically, there were significant dose-related differences in the severity of intra-acinar vacuolization, interstitial edema, neutrophil infiltration, individual cell necrosis, and hemorrhage. Levels of intrapancreatic elastase were elevated and local pancreatic blood flow was reduced. Treatment with FOY improved the FK-506-induced acute pancreatitis, but did not increase the pancreatic blood flow. These findings indicate that FK-506 enhances abnormal pancreatic enzyme secretion and suggest that therapeutic doses of this agent can induce acute pancreatitis when the pancreas is stimulated. A protease inhibitor may protect the exocrine pancreas in patients who receive FK-506 after organ transplantation.

Thymus carcinoid producing parathyroid hormone (PTH)-related protein: report of a case

We report herein the rare case of a thymus carcinoid producing parathyroid hormone (PTH)-related protein (PTHrP) found in a 43-year-old Japanese man who presented with a 19-month history of dyspnea. The diagnosis of a carcinoid was established by light microscopic, electron microscopic, and immunohistochemical examinations. The tumor was considered to be thymic in origin because of its anatomic location, the presence of feeders to the tumor (derived from the internal thoracic arteries), and the fact that no other tumors from which it could have originated were found. After an excisional biopsy, which revealed PTH-related immunoreactivity in the tumor cells, 60 Gy of irradiation was delivered, resulting in a 48% reduction in the size of the tumor. Flow cytometry showed a diploid DNA pattern, with 94% of the cells in the G1 phase, 4% in the S phase, 2% in the G2 + M phase, and a G2 + M/G1 ratio of 1.95. The primary cell culture showed some cells adopted in a cord-like pattern. To our knowledge, this is the first report of a carcinoid tumor in which positive staining for PTHrP by immunohistochemical methods was demonstrated.

Structure of the genomic DNA encoding cucumber ascorbate oxidase and its expression in transgenic plants

Genomic DNA (Aso1) encoding the ascorbate oxidase (ASO) of cucumber (Cucumis sativas) was cloned and sequenced. From a comparison of the sequences of Aso1 and its cDNA [Ohkawa et al. Proc. Natl. Acad. Sci. USA 86 (1989) 1239-1243], it was concluded that Aso1 consisted of four exons and three introns. In the 5'-flanking region, sequence motif resembling a TATA box and a CAAT box, were found 124 and 218 bp upstream, respectively, from the start codon. Sites of initiation of transcription, determined by primer extension, were the A and G residues located 90 and 93 bp, respectively, upstream from the initiation codon. ASO was abundant in cucumber fruits and stems. The 5'-flanking region, placed upstream of the structural gene of β-glucuronidase (GUS), expressed the GUS activity in cucumber plants in a transient expression assay after introduction of DNA with a particle gun. High-level GUS expression was found in stems of transgenic tobacco plants harboring Aso1 promoter-GUS chimeric gene.