Diagnosis of cardiac allograft rejection by the detection of circulating plasma cardiac myosin light chains

Twenty adult male Japanese monkeys of the species Macaca fuscata were randomly paired and subjected to heterotopic cardiac transplantation performed by the Ono-Lyndsey method. Without immunosuppression, graft survival ranged between 8 and 27 days, with a mean survival of 14 days. Plasma cardiac myosin light chains were measured by radioimmunoassay, which showed transient increases in myosin levels just following transplantation. Three hearts showed high values at this period and stopped beating when the myosin levels decreased (type 1). The other 7 hearts showed low myosin values after transient increases and 5 of them were rejected with a preceding reincrease in the myosin levels (type 2). Pathological study revealed myocardial necrosis, perivascular cuffing of mononuclear cells and/or neutrophils and/or plasma cells in the type 1 hearts. Measurement of the plasma myosin light chain level was therefore revealed to be of great value in the monitoring of cardiac allograft rejection.

[Successful resection of mediastinal and abdominal recurrent tumors of esophageal leiomyosarcoma 12 years after surgery]

A 57-year-old woman admitted to our hospital in October, 1988 because of the tumor of the abdominal wall and abnormal shadows of right chest wall and right upper mediastinum. Her esophagus had been resected and reconstructed by the stomach roll because of the esophageal leiomyosarcoma in May, 1976. Clinical examinations revealed that the abdominal mass and chest shadows were the recurrence of the leiomyosarcoma. The abdominal tumor was resected on 17th October, 1988. On 14th December, 1988 right thoracotomy was performed. Chest wall tumor (40 x 30 x 20 mm) and mediastinal tumor (45 x 40 x 35 mm) were resected completely. The mediastinal tumor was adhered to the remnant esophageal muscle layer. Microscopic section of the tumor showed spindle cell sarcoma with fine calcification, and it was diagnosed as the metastatic leiomyosarcoma.

Rotation-advancement flap method for correction of partial anomalous pulmonary venous drainage into the superior vena cava

Three patients with partial anomalous pulmonary venous drainage into the superior vena cava underwent repair by a rotation-advancement flap method. The technique consisted of atrial partitioning, enlargement of the superior vena cava, and protection of sinus node function. Follow-up studies of all patients were done between 12 and 15 months after the operation. The superior vena cava was not stenosed and its diameter was normal, as demonstrated by cavograms. Pulmonary venous return appeared normal on angiograms, and sinus node function was normal by electrophysiologic studies.

[Malignant fibrous histiocytoma of the rib: a case report of repetitive extensive resections and reconstruction of the chest wall]

A forty-seven-year-old woman visited our hospital in March 1987 suffering from the local recurrence of the tumor. Her right 7th and 8th rib had been resected 2 years and 11 months before because of the malignant fibrous histiocytoma (MFH) originated from the right 7th rib. In May 1987, wide resection of the right lateral chest wall and partial resection of the right diaphragm were done. Dacron meshed silicon plate (Silastic) and musculocutaneous flap of the right latissimus dorsi were used to reconstruct the chest wall. Seven months after the second operation, local recurrence occurred again on the anterior chest wall, involving the right diaphragm and right lower lobe of the lung. In March 1988, extensive resection of the anterior chest wall with partial resection of the right diaphragm and the right lower lobe was followed by reconstruction of the chest wall by Silastic. The patient recovered uneventfully without any respiratory disturbances after both operations which included wide resection of the chest wall. Multiple pulmonary metastases were found 4 months after the operation, and she died of respiratory failure 7 months after the final operation. Although MFH was one of the most common sarcomas of the soft tissues, only one case of the MFH originated from the rib had been reported previously in this country. Silastic was proved to be a useful prosthesis for the reconstruction of widely resected chest wall.

[Surgical treatment of Stanford type A acute aortic dissection with stenosis of the branches of aortic arch: report of two cases]

Recently two cases of Stanford type A acute aortic dissection with stenosis of the branches of aortic arch were operated. Both of them had the intimal tear in the ascending aorta, and the stenosis caused by the dissection was present in the left subclavian artery in the first case and in the brachiocephalic and the right common carotid arteries in the second case. Repairs of the dissected ascending aorta were performed successfully with the interposition of the ringed intraluminal graft in the first case, and with the composite graft replacement of the ascending aorta and the aortic valve in the second case. Complete remission or significant relief of the branch stenoses which had not been given direct surgical repairs was observed by the postoperative angiograms.

[Respiratory failure after thymectomy in myasthenia gravis: evaluation of preoperative influencing factors and preventive managements against postoperative respiratory dysfunction]

Postoperative respiratory function was evaluated in 94 patients with myasthenia gravis after thymectomy. Preoperative clinical and pulmonary function data were submitted to statistical analyses. The duration of respiratory support and intratracheal intubation time were significantly correlated to % vital capacity, the clinical stage of myasthenia gravis, and the clinical stage of thymoma. Statistical analyses proved that anticholinesterase drugs taken in immediate postoperative period contributed to the improvement of postoperative respiratory function, and non-depolarizing muscle relaxants, i.e. d-tubocurarine which had been considered to be contraindicated in myasthenia gravis was found to be beneficial immediately after the operation in patients with severely deteriorated respiratory function preoperatively.

[Roentogenologic pathologic evaluation of allograft rejection in heart-lung transplantation--an experimental study in Japanese monkey]

Experimental heart-lung transplantation was carried out in Japanese Monkey (Macaca fuscata). Twelve monkeys survived two to thirty-three days. Pathologic examination of the lung was performed at the time of open lung biopsy and autopsy. Postoperative chest roentogenogram was also studied in seven monkeys. In the early postoperative period, central cloudiness and enhancement of the interstitial change were observed, which started from the second or third postoperative day and reached their peak between the fifth and eighth postoperative day. Pathological study revealed no obvious monocyte infiltration in the lung of this stage. Two types of pulmonary rejection were observed, one is alveolar and vascular rejection. The other is vascular type of rejection, which started as early as in the twelfth postoperative day in a case. In the former, consolidation of the lung was noticed and useful in the diagnosis, but in the latter, no distinct change was observed in plain chest roentogenogram.

[Combined aortic and mitral valve replacement with or without preservation of posterior mitral apparatus]

Seventy patients who underwent aortic and mitral valve replacement were reviewed. 37 patients had the mitral valve replaced with preservation of posterior mitral apparatus (AVR and modified MVR; modified group), and the others without (AVR and conventional MVR; conventional group). Hospital deaths occurred in 4 patients (12.1%) in conventional group and in only 1 patient (2.7%) in modified group. Four out of these five hospital deaths were due to low output syndrome (LOS). The other one died of unknown cause. Severe LOS, necessitating intra-aortic balloon pumping, occurred in 4 (12.1%) in conventional group and in 2 (5.4%) in modified group. In the early postoperative period modified group showed better left ventricular function than conventional group in terms of cardiac index and left ventricular stroke work index. Cardiac performance was evaluated by means of echocardiography at the time of discharge. Modified group showed better fractional shortening and shorter PEP/ET (pre-ejection period/ejection time). These findings suggest that the lower mortality of modified group is due to better left ventricular function preventing LOS in the early postoperative period, and that preserving the posterior mitral apparatus has a more beneficial effect on postoperative left ventricular function even in combined valve disease.

Technical modification of aortic valve replacement in aortitis syndrome--report of a case

In patients who have aortitis syndrome associated with aortic regurgitation, aortic valve replacement (AVR) is frequently complicated by perivalvular leakage (PVL). A 47-year-old male with aortitis syndrome and severe aortic regurgitation was treated by AVR, modified in such a way as to prevent PVL. The aortic cusps were not resected and were placed between Teflon pledgets and the aortic annulus. We believe that this technique is useful for preventing PVL in patients with aortitis syndrome in which the aortic annulus is severely inflammed.

[A false aneurysm caused by rupture of a double velour Dacron graft. A case report]

A 71-year-old man was operated for a complete occlusion of the left common iliac artery caused by arteriosclerosis obliterans. Cross-over bypass was performed from the right external iliac artery to the left superficial femoral artery in June 1978, using a Double Velour Dacron graft (Cooley) 8 mm in diameter. In February 1985, the patient noticed the pulsatile mass in his left groin. Angiography showed a false aneurysm at the distal anastomosis of the graft. On operation, 2 aneurysmal dilatations were found on the distal anastomosis. After resection of the aneurysms, the reconstruction was established by EPTFE graft successfully. The resected specimen showed that one of the aneurysms was caused by the anastomotic failure of the distal portion of the graft, but that the other was the false aneurysm caused by rupture of the implanted graft. Two ruptured holes were confirmed to be 20 X 25 mm, 10 X 15 mm in size respectively, 10 mm proximal to the anastomotic aneurysm. Rupture of the Dacron arterial prosthesis is a rare complication. Only 23 cases have been reported in the United States. But some literatures show that the incidence of the failure of the Dacron prosthesis was about 3%. Therefore, we should make a long-term follow-up to the patients implanted Dacron arterial prostheses.

Bioactive gangliosides: analysis of functional structures of the tetrasialoganglioside GQ1b which promotes neurite outgrowth

Previous reports from our laboratory showed that tetrasialoganglioside GQ1b, when exogenously added, can promote cell proliferation and neurite outgrowth in two human neuroblastoma cell lines, GOTO and NB-1 (Tsuji, S., Arita, M. and Nagai, Y. (1983) J. Biochem. 94, 303-306). To clarify the activity-associated structure of GQ1b, we analyzed the structure-activity relationships using the GQ1b molecule, derivatives of it, and related gangliosides. When the GQ1b molecule was divided into two parts, the ceramide and oligosaccharide moieties, no activity was found with the former, while with the latter the activity could be seen, although the level of activity obtained never exceeded half that of GQ1b itself and an optimal concentration of 100-200 ng/ml of 20-40-times that of native GQ1b (5 ng/ml) was required. Furthermore, the activity of GQ1b was completely abolished by neuraminidase treatment, which converted GQ1b to GM1, so we examined other molecular species of gangliosides having a common gangliotetraose backbone but linked differently with two to four sialic acids (i.e., GD1a, GD1b, GT1a, GT1b, GQ1b and GQ1c). Among them, only GQ1b was found to be active. The results disclosed the interesting fact that deletion of any sialic acid residue from either of the two disialosyl residues of GQ1b results in a complete loss of activity and that the mere existence of the tetrasialosyl structure does not lead to activity; this indicates the absolute necessity of the GQ1b oligosaccharide structure for the expression of activity. For full expression of the activity, both the ceramide and oligosaccharide moieties were necessary. It was also found that the GQ1b oligosaccharide inhibited the activity of GQ1b at a concentration a few times greater than that of GQ1b, suggesting the involvement of a receptor-like mechanism in the action of GQ1b at the cell membrane.

[A case of mesenteric venous thrombosis: its sonographic and computed tomographic findings]

Primary mesenteric venous thrombosis is a rare disease and it is difficult to diagnose preoperatively. In this report, we present a case with interesting sonographic and computed tomographic findings. On March 15, 1984, a 53-year-old male was admitted to Central Hospital of Social Insurance because of intracranial hematoma, which was removed immediately. On May 17, the patient complained of a vague abdominal pain, in the left upper quadrant. Seven days later, the pain became severe and he was referred to our department. White blood cell count was 19300/mm3. On ultrasound and computed tomographic examination, a rigid thick-walled bowel loop was visualized. Laparotomy was performed and a gangrenous bowel loop (35cm long) was resected. Postoperative course was well. It should be emphasized that ultrasound and computed tomography are noninvasive and may be very helpful for differential diagnosis in the cases of acute abdomen.

Bioactive gangliosides. IV. Ganglioside GQ1b/Ca2+ dependent protein kinase activity exists in the plasma membrane fraction of neuroblastoma cell line, GOTO

A ganglioside-stimulated protein phosphorylation system was discovered in plasma membrane fractions of human neuroblastoma cells (GOTO). Gangliosides (GQ1b, GT1a, GT1b, GD1a, GD1b, GD3, and GM1) could stimulate this system. GQ1b showed the most effective stimulation among these gangliosides. The substrate specificity was rather broad. Not only some (de novo) proteins of the membranes but also purified histones and tubulin were phosphate-acceptable. This protein phosphorylation system specifically depended upon Ca2+ (optimum concentration: 50-100 microM). The optimum pH was 7.0-7.5. GQ1b/Ca2+ could not directly activate well known protein kinases (Ca2+/phospholipid-activated protein kinase, Ca2+/calmodulin-activated protein kinase, and cyclic nucleotide-dependent protein kinases). Furthermore, GQ1b could replace neither phospholipids nor calmodulin. Thus, an unknown, new type of protein kinase(s) may be involved in this system. Alternatively, GQ1b may activate some known protein kinase(s) in cooperation with another unknown factor which may be removed during the preparation of the partially purified known protein kinase used in this experiment.