Analysis of adenoid cystic carcinoma treated by radiotherapy

The records of 41 patients with adenoid cystic carcinoma of the head and neck region who had been treated with radiotherapy were reviewed. Local control was achieved in 72.3% in the cases with primary lesions at 5 years. The prognosis for tumors that arose in the major salivary glands was better than that for tumors that arose in the minor salivary glands; however, the difference was not statistically significant. In the minor salivary glands, early-stage tumors were well controlled with the use of radiation therapy alone. In spite of the high local control rate, the disease-free survival rate of the patients at 10 years was only 20.8%. Lung metastasis determined the prognosis.

[A case of pheochromocytoma in pregnancy]

A 29-year-old woman was referred to our hospital at the 34th week of her first pregnancy with a diagnosis of severe pregnancy-induced hypertension. A diagnosis of pheochromocytoma was made by elevated values of serum and urinary noradrenaline. Ultrasonography and computed tomography revealed a left adrenal tumor. Caesarean section combined with removal of the tumor at the 36th week of gestation was performed with a satisfactory result obtaining a healthy mother and an infant. Current management of patients with a pheochromocytoma during pregnancy is discussed.

Structure of the chicken growth hormone-encoding gene and its promoter region

We have cloned the chicken (c) growth hormone (GH)-encoding gene cGH and analyzed its nucleotide sequence including 500 bp of the 5'-flanking region. The cGH gene consists of five exons and four introns as has been observed in the mammalian GH genes. However, the size of the cGH gene is significantly larger than that of analogous mammalian genes, because of its intron size which expands it to 3.5 kb. The transcription start point was determined to be 56 bp upstream from the start codon by the primer-extension analysis. The promoter region of the cGH gene has no overall homology with the corresponding regions of mammalian genes, but contains a short (24 bp) sequence which is highly homologous to the antisense strand sequence of the proximal binding site for a pituitary-specific transcription factor, GHF-1/Pit-1, in the promoter region of the rat GH gene.

Increased soluble CD4 and decreased soluble CD8 molecules in patients with Sjögren's syndrome

PURPOSE

A new enzyme-linked immunosorbent assay for soluble CD4 (sCD4) and soluble CD8 (sCD8) molecules has been developed. We estimated the concentrations of these molecules in patients with Sjögren's syndrome and in patients with systemic lupus erythematosus (SLE) serving as a control population for non-Sjögren's inflammatory disease, since several findings suggestive of an aberration of immunocompetent cells have been reported in these autoimmune diseases.

PATIENTS AND METHODS

The study population consisted of 41 patients with Sjögren's syndrome (28 cases of the primary form and 13 cases of the secondary form), 66 patients with SLE, and 43 normal individuals. Serum samples and clinical and laboratory data were collected from each patient and control. Assays of the sCD4 and sCD8 molecules were performed using an enzyme-linked immunosorbent kit developed by T Cell Science Inc., Cambridge, MA.

RESULTS

The concentration of sCD4 was significantly increased in patients with both primary and secondary Sjögren's syndrome as compared with that in the control subjects. In contrast, sCD8 was significantly decreased in patients with primary disease but not in patients with secondary disease. A low or high concentration of sCD8 was significantly correlated with the presence of anti-SS-A antibody or hypocomplementemia, respectively. A similar significant correlation was noted between an increased sCD4 concentration and increased serum IgG level. In patients with SLE, the levels of both sCD4 and sCD8 were significantly increased.

CONCLUSION

These observations represent the first evidence of an increased level of the sCD4 molecule and a decreased level of the sCD8 molecule and an association with immunologic abnormalities in Sjögren's syndrome. The increased and decreased levels of these soluble molecules observed may play a pathologic role in patients with Sjögren's syndrome.

Cardiac fibroma. Long-term fate after excision

Between 1980 and July 1983 three infants and children with cardiac fibromas underwent surgical resection at Kobe Children's Hospital. Two of them survived and have an excellent clinical result 6 years and 7 years postoperatively. The results of late follow-up with the use of 24-hour dynamic electrocardiography, two-dimensional echocardiography, thallium-201 myocardial scintillation scan, and technetium 99m sodium pertechnetate-gated blood pool imaging have proved that the patients are free of arrhythmic episodes, free of recurrence of tumor, have no significant myocardial perfusion defect, and have normal left ventricular function.

In situ hybridization for the demonstration of bovine leukemia virus transcripts in lymphosarcoma cells using biotinylated probes

Bovine leukemia virus (BLV) RNA was demonstrated in peripheral blood lymphocytes treated with concanavalin A or phytohemagglutinin from a BLV-infected ox, and in lymphosarcoma cells cultured without mitogen from an enzootic bovine leukosis cow by in situ hybridization using biotinylated DNA probes.

[Results of open heart surgery in neonates--comparison between profound hypothermia with circulatory arrest and deep hypothermic bypass]

To investigate factors affecting surgical outcome of open heart surgery in neonates, a retrospective review was carried out on 38 patients operated in the 9 years period from May 1981 to August 1990, in our institution (TAPVR19, TGA7, HLHS7, and others 5). In the former 3 years and 9 month period, 12 patients were operated with the use of profound hypothermia and circulatory arrest (Group I) and in the latest 5 year and 5 month period, continuous deep hypothermic bypass was used in all but for 7 patients with HLHS (Group II). In the group of neonates with TAPVR, operative mortality improved to 7% (1 of 14) in Group II compared to that of 60% (3 of 5) in Group I. CVP and LAP measured immediately after cessation of cardiopulmonary bypass (CPB) were lower in Group II and the value of CPK-MB was significantly lower in Group II. There was a significant negative correlation (r = -0.695, p less than 0.05) between CPB time and urine volume for 72 hours after operation. A significant negative correlation (r = -0.899, p less than 0.01) was also obtained between CPB time and urine volume in the group of 7 neonates with TGA. There was no significant difference in urine volume between patients with TAPVR and TGA despite of significantly longer CPB time in patients with TGA. It is concluded that, 1) improved protection of cardiac and renal function was obtained in neonates operated with the use of continuous deep hypothermic bypass, 2) surgical outcome was influenced by the method of CPB, CPB time and differences in cardiac function ascribed to primary lesions.

The necessity of dietary vitamin B6 to selenium biopotency for tissue selenium and glutathione peroxidase in rats

Necessity of dietary vitamin B6 to the biopotency of selenium (Se) for the levels of Se and glutathione peroxidase (GSH-Px) in tissues was investigated. Male Wistar 12-week-old rats were fed a vitamin B6-Se-deficient basal diet for 3 weeks, and then the rats were divided into 6 groups. One group was fed the basal diet, the others were fed the diet supplemented with 250 micrograms vitamin B6/100 g as pyridoxine.HCl, or 0.25 mg Se/kg as Na2SeO3 (SeL) or DL-selenomethionine (Se-Met), or both (SeL+B6 or Se-Met+B6) for 10 week. The levels of Se and GSH-Px in erythrocytes and muscle were significantly higher in vitamin B6-supplemented groups than in vitamin B6-deficient groups. There was little effect of this vitamin deficiency on Se level in liver of rats fed SeL; however, a higher Se level in liver was observed in vitamin B6-deficient rats fed Se-Met than in the corresponding B6-supplemented rats. A significant decrease of GSH-Px activity in liver was found in vitamin B6-deficient animals fed Se-Met compared with vitamin B6-supplemented animals, whereas no significant decrease was observed in those fed SeL. These results suggest that this vitamin is involved in the transport and deliverance of Se in plasma to the other tissues and the incorporation of Se from Se-Met to GSH-Px in liver.

Alternating current induced otoacoustic emissions in the guinea pig

Injection of alternating current (AC) into the scala media of the guinea pig cochlea induced otoacoustic emissions (OAEs) at the frequency of the AC fundamental, together with harmonic and intermodulation distortion products. Although the waveform of the injected ACs was distorted, probably due to nonlinear polarization of the metal electrodes, and was composed of the fundamental plus distortion products of every order, only a few of the lowest order distortion products were selectively emitted with the fundamental. AC injection at a basal site extended the high frequency limit of OAEs. Electrical stimulation of the crossed olivocochlear bundle inhibited the sideband emissions with little change in the fundamental. OAE was reduced reversibly by temporary impairment of the cochlea due to exposure to fatiguing sound, by intravenous application of furosemide and by temporary anoxia. Irreversible reduction resulted from intracochlear perfusion with excess K+ solution, acoustic trauma and cardiac arrest. These facts imply that AC-induced OAE is not an artifact generated electrically; rather, such emissions originate in the cochlea and normal metabolic activity in the cochlea is essential. A proposed mechanism of generation includes two components: 1) electromechanical transduction from AC to mechanical vibration in the cochlea and 2) a distortion-producing process; the contribution of each component to the receptor mechanism is discussed.

[Successful surgical treatment of primary chylopericardium in infant--a usefulness of intraoperative thoracic ductgraphy]

Asymptomatic eight-year old girl was admitted to our surgical department from ophthalmology complaining enlarged heart size at the routine check before operation of strabismus. By pericardiocentesis it was confirmed that pericardial effusion was chyle biochemically and microscopically. In spite of several medical trials (i.e. diuretics, pericardial drainage, complete starvation with parenteral nutrition), copious amount of chyle discharge, measured 180 ml per day, couldn't be controlled. Mediastinal mass lesion and thoracic duct anomaly were excluded by both thoracic CT and lymphangiography, and primary chylopericardium without thoracic duct anomalies was suspected preoperatively. The diagnosis of primary pericardium was confirmed by intraoperative thoracic ductography which visualized thoracic duct and it's tributaries more clear than that of preoperative lymphangiography. Low thoracic duct ligation with resection of duct 55 mm in length and fenestration of the pericardium through right thoracotomy was successfully carried out. She was discharged on 8th day after surgery without any problems. She is doing well 7 months postoperation after discharge with reduced heart size and returns to normal activity. We concluded that intraoperative thoracic ductography had some advantages in terms of more clear visualization of thoracic duct anastomosis, precise diagnosis of etiology and choice of surgical options.

[Closed stuck valve diagnosed by echocardiogram immediately after mitral valve replacement: a case report]

The patient was a 52-year-old woman who suffered from mitral valve regurgitation due to torn chordae. Mitral valve replacement (Medtronic-Hall 27 mm) was performed on Jan. 30, 1990. Immediately after the operation cardiac pacing was necessary for bradycardia, but one hour later cardiac rhythm changed to atrial fibrillation and the patient received an injection of verapamil. After the treatment of tachycardia, electro-mechanical dissociation (EMD) appeared on monitor. Bed side M-mode echocardiogram disclosed a restriction of the disc opening, but abnormal structures were not detected by B-mode echocardiogram. By repeated echocardiogram, the disc opening was normally demonstrated on M-mode, but B-mode showed an abnormally high echo structure in the left ventricle just below the prosthetic valve. Under the diagnosis of stuck valve in the closed position due to remnants of chordae, reoperation was performed. An eight mm remnant of chorda was found on the posteromedial side of the posterior leaflet, and it was supposed that the compression of the remnant between the disc and the valve ring restricted the valve opening. The remnant was resected through the large orifice of the Medtronic-Hall valve. After the reoperation, EMD was not detected and prosthetic valve insufficiency was not noted on echocardiogram. The patient left the hospital in a good condition three weeks after MVR.

Novel oligomannose-type sugar chains derived from glucose oxidase of Aspergillus niger

The primary structure of the N-linked sugar chains of glucose oxidase from Aspergillus niger was investigated. These sugar chains were released from the polypeptide backbone by hydrazinolysis, and the reducing ends of the sugar chains were pyridylaminated. HPLC of the pyridylamino sugar chains with an amide-silica column showed at least seven sugar chain peaks. Chemical and exoglycosidase digestion and 400 lMHz H-NMR studies of the sugar chains of lower molecular weight showed that these were novel oligomannose-type sugar chains, (Man)5-7 (GlcNAc)2, with the structure: +/- Man alpha 1----3Man alpha 1----3(Man alpha 1----6)Man alpha 1----6(+/- Man alpha 1----3Man alpha 1---3)Man )Man beta 1----4GlcNAc beta 1----4GlcNAc.

Synthesis and expression of genes encoding tuna, pigeon, and horse cytochromes c in the yeast Saccharomyces cerevisiae

Genes encoding tuna, pigeon, and horse cytochromes c were constructed with synthetic oligodeoxyribonucleotides having preferred codons and portions of the iso-1-cytochrome c-encoding gene from the yeast Saccharomyces cerevisiae. The genes were ligated into an expression vector, which contains the normal 5'- and 3'-untranslated regions of the yeast iso-1-cytochrome c gene, and were integrated in single copy into the chromosome. Yeast strains were also constructed with multiple integrated copies of the pigeon gene. The heterologous and normal mRNA levels of the single-copy strains were equivalent. Although the N-terminal methionines were completely cleaved in the heterospecific proteins, the levels of trimethylation of Lys72 and acetylation of N-terminal glycines ranged from 39-78% and 10-70%, respectively. Horse cytochrome c was produced at a nearly normal level, whereas the pigeon and tuna cytochromes c were produced at approx. 40% of the normal levels. The levels of the cytochromes c and growth of the mutant yeast strains indicated that the heterospecific cytochromes c had approx. 50% specific activity in vivo.

Pleomorphic xanthoastrocytoma. Ultrastructural, immunohistochemical, and DNA cytofluorometric study of a case

A case of right frontal pleomorphic xanthoastrocytoma that occurred in a 7-year-old boy is reported clinicopathologically. The patient underwent surgery on September 29, 1988. Histologic diagnosis of pleomorphic xanthoastrocytoma was made because, in addition to the unique pleomorphic histologic features, positive glial fibrillary acidic protein in immunohistochemical staining and characteristic ultrastructural features, i.e., cytoplasmic intermediate fibrils and lipid vacuoles, basal lamina, and abundant reticulin networks were demonstrated. The DNA cytofluorometric analysis of the nuclei of the tumor cells disclosed the main mode to be diploid with polyploid classes (4, 8, 16, and 32C) without any aneuploidy. Despite the presence of many pleomorphic nuclei, DNA histogram of the tumor disclosed very few DNA synthetic cells indicating a biologically inactive nature of the tumor. The patient is still alive and totally asymptomatic 20 months postoperatively.

Pulmonary origin of left anterior descending coronary artery in tetralogy of Fallot

We report the case of a 4-year-old girl with an anomalous origin of the left anterior descending coronary artery from the pulmonary artery in association with tetralogy of Fallot. Creation of an intrapulmonary tunnel from a newly created aortopulmonary window to the coronary ostium in the pulmonary trunk and total repair of tetralogy of Fallot were successfully carried out. The advantage of intrapulmonary tunnel technique (Takeuchi method) for this very rare combination is stressed.

Bilateral enlargement of the aortic valve ring for valve replacement in children. New operative technique

We report a new technique for the bilateral enlargement of a small aortic anulus in two children by the insertion of a bifurcated teardrop-shaped Dacron fabric lined with a porcine pericardium. Our experience in two children indicates that this technique will permit the insertion of a prosthetic valve that is four sizes larger than that measured with the native anulus intact in children weighing around 15 kg. It entails no risk of distorting the mitral valve, damaging the conduction system, the main coronary arteries or their important trunks, or of leading to left ventricular dysfunction.

Mucosal lesions of the stomach in liver cirrhosis with a special reference to phospholipid metabolism

Gastric mucosal lesions are an inevitable complication in patients with liver cirrhosis. Their etiology, however, is as yet unknown. The present study investigated phospholipid metabolism in the gastric mucosa of rats with cirrhosis induced by carbon tetrachloride. Gastric mucosal lesions were induced by taurocholic acid (TCA) which was given through a gastric tube. Levels of phospholipids, phosphatidylcholine, and disaturated-phosphatidylcholine were found to be markedly reduced at the mucosal surface in the cirrhotic rats, and they were increased in the gastric juice. Metabolism of phospholipids in the gastric mucosa was visualized by 3H-choline autoradiography and the rate of phospholipid metabolism was found to be reduced. These results strongly suggest that mucosal lesions induced by bile regurgitation into the stomach are due to disturbance of phospholipid metabolism in the gastric mucosa.

[Effects of nasal continuous positive airway pressure (NCPAP) on nocturnal renal function in obstructive sleep apnea syndrome (OSAS)]

Nocturnal renal function was examined in 8 patients with obstructive sleep apnea syndrome (OSAS) and the effects of nasal CPAP (NCPAP) on renal function were also studied. Nocturia was observed more than twice in all cases when no treatment was performed, but it disappeared after initiation of NCPAP. Fractional nocturnal urine volume and creatinine clearance decreased significantly from 1.36 +/- 0.15 ml/min to 0.75 +/- 0.20 ml/min (p less than 0.01) and from 116.8 +/- 46.5 ml/min to 101.1 +/- 33.0 ml/min (p less than 0.05), respectively, after initiation of NCPAP. Although the serum Na and creatinine did not change following NCPAP, the urine Na and creatinine changed significantly after NCPAP therapy. The serum renin, aldosterone, and ADH did not change after NCPAP therapy. The significant positive correlation (p less than 0.05) between the fractional nocturnal urine volume and DI, and also significant inverse correlation (p less than 0.05) between the fractional urine volume and %FRC were observed. These results suggest that the abnormal renal function seen in cases of OSAS is related to the hypoxemia during sleep. It was concluded that the nocturnal renal function in cases of OSAS was different from those in normal controls and NCPAP therapy induced the recovery of these abnormalities.

[Aortocoronary bypass for coronary ostial stenosis following aortic valve replacement: a report of successfully treated case]

A 62-year-old man underwent aortic valve replacement with a Medtronic-Hall valve (21 mm) for aortic stenosis and regurgitation with normal coronary arteries. An intermittent selective coronary perfusion with metal tip cannula was employed for both the coronary arteries. Postoperative course was uneventful. However, he began to complain of chest pain six months later. Cardiac catheterization and coronary arteriography revealed a normally functioning valve with 75% stenosis at the main trunk of the left coronary artery. Coronary bypass grafting using a saphenous vein was successfully performed to the left anterior descending coronary artery and the circumflex of the coronary artery. Whenever this fatal complication of the coronary ostial stenosis is recognized, earlier coronary revascularization should be recommended to save the severely ill patient.

[Surgical treatment for the association of cardiovascular disease and cholelithiasis]

Six cases of the association of cardiovascular disease and cholelithiasis were treated in our surgical ward. Simultaneous operation was carried out for four of them, and two-stage operation was performed in the remaining two cases. As the time of the simultaneous operation, reconstruction of the abdominal aorta and cardiac surgery was firstly done, and cholecystectomy was secondly performed after closing the retroperitoneum or the median sternotomy. All of these cases were discharged from hospital uneventful. In conclusion, cholecystectomy could be safely performed at the same time of the aortic reconstruction and cardiac surgery without any high risk for the patients.

[A case of successful treatment of aneurysms of the suture line following Bentall's operation]

A 33-year-old male who had received Bentall's operation 10 years ago was admitted to our hospital with severe chest pain. The pseudoaneurysm at the right coronary ostium was observed on angiography and CT scan. He underwent the repair of the anastomosis between the graft and the right coronary ostium under extracorporeal circulation. Although he was discharged from the hospital asymptomatically, he was again admitted to our hospital with severe chest pain and back pain 4 months after re-operation. Aneurysmal formation of the ascending aorta due to blood leakage from the distal anastomotic suture line was observed and the graft was compressed by hematoma on angiography and CT scan. He underwent re-operation of the distal anastomosis of the graft, and could be discharged from the hospital uneventfully.

Congenital mitral regurgitation associated with total anomalous pulmonary venous drainage. Report of a rare combination

A case of congenital mitral regurgitation associated with total anomalous pulmonary venous drainage, successfully treated surgically, is reported. To our knowledge, this combination has not been reported in the literature.

Existence of common homologous elements in the transcriptional regulatory regions of human nuclear genes and mitochondrial gene for the oxidative phosphorylation system

Our previous study indicated that nuclear protein factors of HeLa cells specifically bind to three nuclear Mt elements, Mt1, Mt3, and Mt4, located in the 5'-flanking regions of the human nuclear genes for cytochrome c1 and for ubiquinone-binding protein, both of which are subunits of mitochondrial cytochrome bc1 complex (Suzuki, H., Hosokawa, Y., Toda, H., Nishikimi, M., and Ozawa, T. (1990) J. Biol. Chem. 265, 8159-8163). In this study, we examined whether the same nuclear factors could recognize a set of the Mt3 and Mt4 elements that were found in the displacement loop and the promoter region of mammalian mitochondrial genomes. Gel retardation experiments disclosed that the same nuclear protein factors specifically bind to those Mt elements in the human mitochondrial genome as well as to the nuclear Mt3 and Mt4 elements of the two genes, and that the coexistence of both the elements is required for the efficient binding. The nuclear protein factors which recognize the Mt elements located in the regulatory regions of the nuclear and mitochondrial genes may play an important role in coordinate expression of the two physically separated genes during mitochondrial biogenesis.

Effects of dietary zinc and cadmium on tissue selenium concentration and glutathione peroxidase activity in rats fed DL-selenomethionine or sodium selenite

The effects of dietary zinc (Zn) and cadmium (Cd) on tissue selenium (Se) concentration and glutathione peroxidase (GSH-Px) activity were studied in weanling male Wistar rats. One group of rats was fed a purified diet based on casein and sucrose, and the other rats used in a 2 x 2 x 2 factorial arrangement of treatment were fed this diet supplemented with 0.1 mg Se/kg, either as DL-selenomethionine or sodium selenite and plus 100 mg Zn/kg as zinc sulfate or 5 mg Cd/kg as cadmium chloride or both for 4 weeks. Se concentrations in plasma, erythrocytes, muscle, heart, and liver were significantly elevated by Zn. Cd significantly decreased Se concentration in muscle. Addition of Zn to the diets markedly increased (p less than 0.001) hepatic GSH-Px activity. However, Cd in the diets produced a significant increase (p less than 0.001) in erythrocyte GSH-Px activity. These results indicate that Zn level of marginal deficiency (8.6 mg/kg diet) can decrease Se availability and a small excess of Zn increases Se availability for hepatic GSH-Px activity.