Irreducible Salter-Harris type II fracture of the distal tibial epiphysis

An 11-year-old boy was admitted to the hospital after he fell to the ground from the roof, complaining of pain in his left ankle. Radiographs showed a Salter-Harris type II fracture-separation of the distal tibial epiphysis together with a transverse bending fracture of the distal fibula. An attempt at closed reduction was unsuccessful. At open reduction, torn periosteum and the posterior tibial tendon were interposed between the tibial metaphysis and epiphysis. After the tendon was deflected to its normal position, fracture-separation of the distal tibial epiphysis was easily reduced. At the latest follow-up 4 years after surgery, radiographs showed no evidence of growth arrest or residual deformity.

[Coronary artery bypass grafting in a patient with right aortic arch associated with retroesophageal anomalous left subclavian artery]

A rare case of coronary artery bypass grafting in a patient with right aortic arch was presented. A 62-year-old man was admitted to our hospital with angina pectoris. Coronary angiography revealed total obstruction of left anterior descending artery and jeopardized collateral from right coronary artery. Aortography disclosed right aortic arch associated with retroesophageal anomalous left subclavian artery. As the symptom of neither the vascular ring nor the subclavian steal syndrome was recognized, left internal thoracic artery along with the saphenous vein was used for bypass conduit. The patient is doing well without any troubles 7 months after the operation. Attention should be made to use left internal thoracic artery in a patient with right aortic arch.

A simple procedure for assigning a sequence motif with an obscure pattern: application to the basic/helix-loop-helix motif

We have developed a simple method to assign a sequence motif with an obscure pattern. Given a multiple sequence alignment for a region of protein that is known or strongly believed to have the same secondary and tertiary structures, the quantification method by principal component analysis is designed to find the regions most likely to have the same structure in a protein outside of the original set. The potential of this newly developed method was evaluated with reference to the known basic/helix-loop-helix (bHLH) motifs, and its characteristics were discussed with four obscure but well-defined motifs and compared with the other methods for searching sequence motifs. The method was also applied to assign the bHLH motif in Epstein-Barr virus nuclear antigen 1 (EBNA-1). This application revealed one candidate for the basic/helix 1 region and two candidates for the helix 2 region in the bHLH motif, within the region from amino acid residues 460 to 600, which is in good agreement with our previous experimental studies on the DNA binding region of EBNA-1. The basic/helix-loop-helix-loop-helix structure thus assigned suggests a function of EBNA-1 which is associated with both replication and transcription.

Fourier-transform speckle profilometry: three-dimensional shape measurements of diffuse objects with large height steps and/or spatially isolated surfaces

An interferometric technique for automated profilometry of diffuse objects has been proposed. It is based on the Fourier-fringe analysis of spatiotemporal specklegrams produced by a wavelength-shift interferometer with a laser diode as a frequency-tunable light source. Unlike conventional moiré techniques the proposed technique permits the objects to have discontinuous height steps and/or surfaces spatially isolated from one another. Experimental results are presented that demonstrate the validity of the principle.

[An adult case of bronchodilation using stents for right aortic arch]

Airway obstruction due to oppression by the right aortic arch is relatively common in the newborn, but has never been reported in the adult. We reported an aged case of right main bronchial stenosis due to the oppression by the right aortic arch, performed successful bronchodilatation using the stent. A 92-year-old male complained of fever and productive cough and hospitalized with a diagnosis of pneumonia. Close examinations revealed that his right main bronchus was stenotic due to oppression by the right aortic arch. Bronchodilatation was performed successfully using a Gianuturco-type expandable metallic stent. No endoluminal stenosis was found during 12 months follow up. For the treatment of bronchial deformity by the extrabronchial oppression, implantation of the Gianturco-type expandable metallic stent is considered to be very useful method.

[Myocardial preservation by continuous perfusion of Krebs-Henseleit solution--the temperature dependency of the optimal perfusion pressure]

The aim of this study was to determine the temperature dependency of the optimal pressure in myocardial preservation by continuous perfusion with Krebs-Henseleit bicarbonate buffer (KHBB) solution. Hearts from Wistar male rats were perfused with KHBB solution and cardiac function (aortic flow) was measured using an isolated working rat heart preparation. In the preliminary experiment, hearts were then preserved using Langendorff perfusion with KHBB solution of 37, 20 or 4 degrees C for 2 hours at a perfusion pressure of 100 cmH2O. This was followed by 15 min of Langendorff perfusion (37 degrees C, 100 cmH2O) and 20 min working perfusion. The 37 degrees C group and 20 degrees C group exhibited better functional recoveries of aortic flow (%AF) in the post-preservation period compared to the 4 degrees C group. In the test experiment, hearts were preserved using Langendorff perfusion for 4 hours at 37 degrees C or for 8 hours at 20 degrees C at various perfusion pressures. At 37 degrees C, %AF after 4 hours of the preservation were 64.7 +/- 2.6, 69.0 +/- 3.2, 81.9 +/- 3.1, 94.7 +/- 3.3 and 63.5 +/- 4.0% (p < 0.05 vs the 100 cmH2O group) at the perfusion pressure of 100, 60, 20, 15 and 10 cmH2O, respectively. %AF after 8 hours of the preservation at 15 cmH2O was 56.3 +/- 2.5%. At 20 degrees C, %AF after 8 hours of the preservatin was 78.9 +/- 3.3, 81.9 +/- 2.3, 67.4 +/- 1.9 and 65.9 +/- 2.2% (p < 0.05 vs the 60 cmH2O group) at the perfusion pressure of 60, 30, 10 and 15 cmH2O, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Controversies in the surgical options for the patient with primary breast cancer]

We analysed the results of relapse free survivals for breast cancer patients treated with traditional mastectomy through 10 years of follow up. In the consecutive series of 162 patients with Stage III breast tumor, we noted that the mastectomy followed by radiation to axilla and adjacent area failed to confirm the efficacy to support the prevention for local and distant relapse in the past decade (1962-1974) (27.2%). The concepts of neoadjuvant and/or adjuvant chemotherapy were evolved primarily from clinical trials: these have been shown to influence favorably for the 228 patients with STAGE III in the next decade (1975-1985) (46.1%). Modified mastectomy, which involved removal of the breast, overlying skin and axillary contents but spares the pectoralis muscle, has recently been established as an entirely satisfactory approach for STAGE I (295 patients) and STAGE II (281 patients) breast carcinomas (1986-1991). Five-year relapse free survivals of these 2 categories calculated 93.7% and 86.8%, respectively. In recent studies, the many trials to breast conservation therapy reported, such as partial mastectomy plus nodes dissection with or without radiotherapy for selected patients with early cancer represent as effective results as modified mastectomy. Breast preservation has focused attention on the extent and distribution of cancer (multifocality, residual foci of surgical margin, etc) for clinicians.

Effects of the major metabolite of phencyclidine, the trans isomer of 4-phenyl-4-(1-piperidinyl)cyclohexanol, on [3H]N-(1-[2-thienyl] cyclohexyl)-3,4-piperidine ([3H]TCP) binding and [3H]dopamine uptake in the rat brain

The major metabolite of phencyclidine (PCP), the trans isomer of 4-phenyl-4-(1-piperidinyl)cyclohexanol [(trans)-4-PPC], inhibited [3H]N-(1-(2-thienyl)cyclohexyl)-3,4-piperidine ([3H]TCP) binding to well-washed rat cortical membranes with much less activity than PCP itself. In contrast, it inhibited [3H]dopamine ([3H]DA) uptake in rat striatal synaptosomes to a similar extent as PCP. Considering our previous observations that intraperitoneally administered (trans)-4-PPC elicits dose-related increases in locomotor activity and rearing in mice, (trans)-4-PPC as well as PCP may be involved in psychotomimetic effects of PCP due to its inhibitory effect on DA uptake.

Behavioral effects of phencyclidine and its major metabolite, (trans)4-phenyl-4-(1-piperidinyl)cyclohexanol, in mice

To elucidate the biological activity of natural metabolites of phencyclidine (PCP), we examined the behavioral effects of a major metabolite, the trans isomer of 4-phenyl-4-(1-piperidinyl)cyclohexanol [(trans)PPC], in mice, (Trans)PPC caused dose-related increase in locomotor activity and rearing in mice when injected intraperitoneally at the doses ranging from 10 to 30 mg/kg. (Trans)PPC at any dose tested failed to produce swaying and falling. On the other hand, PCP at the doses ranging from 1 to 10 mg/kg caused swaying and falling as well as hyperlocomotion in a dose-related manner. These indicate that unlike PCP, hyperlocomotion and rearing may be the predominant behavioral responses to (trans)PPC in the 10-30 mg/kg dose range. Furthermore, it is feasible to surmise that not only PCP but also its major metabolite (trans)PPC is involved in psychotic reactions produced by PCP.

[The effect of calcitonin gene-related peptide on the hepatic hemodynamics after releasing of hepatic ischemia]

The effect of synthetic chicken calcitonin gene-related peptide (CGRP) on the hepatic circulation was studied using adult mogrel dogs. Infusion of CGRP (10(-9) M/kg) decreased the mean arterial blood pressure to 56.8% of the pre-infusion value and increased heart rates to 106.3%. 10(-10) M/kg CGRP increased blood flow of the superior mesenteric artery, hepatic artery and portal vein by 130.1%, 130.2%, and 121.2% respectively of the basal levels. The hepatic blood flow was discontinued for 20 minutes by clamping the hepato-duodenal ligament. After reestablishing effects of CGRP on the hepatic hemodynamics became more evident. These results offer the possibility that CGRP may be used to maintain the hepatic blood flow stable during and after hepatic surgery.

Characterization of the rabbit intestinal fructose transporter (GLUT5)

Recent studies suggest that the jejunal/kidney-type facilitative glucose transporter (GLUT5) functions as a high-affinity D-fructose transporter. However, its precise role in the small intestine is not clear. In an attempt to identify the fructose transporter in the small intestine, we measured fructose uptake in Xenopus oocytes expressing jejunal mRNA from five species (rat, mouse, rabbit, hamster and guinea-pig). Only jejunal mRNA from the rabbit significantly increased fructose uptake. We also cloned a rabbit GLUT5 cDNA from a jejunal library The predicted amino acid sequence of the 487-residue rabbit GLUT5 showed 72.3 and 67.1% identity with human and rat GLUT5 respectively. Northern-blot analysis revealed GLUT5 transcripts in rabbit duodenum, jejunum and, to a lesser extent, kidney. After separation of rabbit jejunal mRNA on a sucrose density gradient, the fractions that conferred D-fructose transport activity in oocytes also hybridized with rabbit GLUT5 cDNA. Hybrid depletion of jejunal mRNA with a GLUT5 antisense oligonucleotide markedly inhibited the mRNA-induced fructose uptake in oocytes. Immunoblot analysis indicated that GLUT5 (49 kDa) is located in the brush-border membrane of rabbit intestinal epithelial cells. Xenopus oocytes injected with rabbit GLUT5 cRNA exhibited fructose uptake activity with a Km of 11 mM for D-fructose. D-Fructose transport by GLUT5 was significantly inhibited by D-glucose and D-galactose. D-Fructose uptake in brush-border membrane vesicles shows a Km similar to that of GLUT5, but was not inhibited by D-glucose or D-galactose. Finally, cytochalasin B photolabelled a 49 kDa protein in rabbit brush-border-membrane preparations that was immunoprecipitated by antibodies to GLUT5. Our results suggest that GLUT5 functions as a fructose transporter in rabbit small intestine. However, biochemical properties of fructose transport in Xenopus oocytes injected with GLUT5 cRNA differed from those in rabbit jejunal vesicles.

[Congenital coronary arterial fistula drained to the coronary sinus--a case report]

We report a very rare case of an infant with coronary arterial fistula in whom the communication between a dilated right coronary artery and the coronary sinus was found. The patient was 1-year-old. She had pulmonary congestion and cardiomegaly due to the left-to-right shunt through the fistula, and underwent ligations of the fistula. Ligations of the fistula was indicated because the patient was too small to undergo a fistula resection and coronary arterial bypass grafting. Although the patient had a successful post-operative course, we are paying attention to the aneurysmal change of the dilated right coronary artery proximal to the site of ligations.

[Effect of shear stress on hemostatic regulation in endothelium]

The vascular endothelium plays a pivotal role in regulating the hemostatic system. Various cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF) are known to perturb endothelial cells to reduce antithrombogenicity. On the other hand, blood flow has been shown to affect the endothelium to maintain its antithrombogenicity under some levels of shear stress in the laminar flow system. We examined the role of hemodynamic forces on the vascular system under cytokine stimulation using a cone-plate type viscometer. Treatment of endothelial cells with either IL-1 beta or TNF-alpha under static conditions increased PAI-1, vWF and prostacyclin release, while t-PA secretion was unchanged. When cells were exposed to steady shear stress of 0, 6, 12, 18 and 24 dyne/cm2, the release of t-PA, t-PA-PAI complex and prostacyclin elevated with the increase of shear stress intensity, while a gradual decrease of total PAI-1 secretion was observed and vWF secretion was unchanged. On the contrary, active PAI-1 secretion was significantly decreased under the shear stress of over 18 dyne/cm2. Interestingly, cytokines, which did not affect t-PA secretion of resting cells, increased the t-PA secretion and had an additive effect on prostacyclin secretion with shear stress under the shear stress of over 18 dyne/cm2. PAI-1 elevation induced by cytokines was markedly abolished under the same shear forces. No additive effect was observed in the secretion of vWF. Thus, shear stress attenuates the alteration of the balance in the fibrinolytic and coagulation system induced by cytokines. These findings clearly indicate that hemodynamic forces play a crucial role in regulating the hemostatic activity in vivo.

Dehydroepiandrosterone fails to improve immunoglobulin synthesis and lymphocyte mitogenic response after burn injury

Dehydroepiandrosterone has been proposed as a means of restoring immune function after injury. In this study we examined the effect of dehydroepiandrosterone on the impaired immunoglobulin M synthesis and depressed lymphocyte mitogenic responses observed after burn injury. We divided BALB/c mice (n = 28) into four equal groups that received either a 25% total body surface area dorsal steam burn or a sham procedure. One hour later we injected mice subcutaneously either with 100 micrograms dehydroepiandrosterone or vehicle alone. Five days later we isolated splenocytes for assessment of immune function. We stimulated splenocytes with lipopolysaccharide and 5 days later measured immunoglobulin M synthesis specific for peptidoglycan polysaccharide, a ubiquitous bacterial antigen. We stimulated additional cultures with lipopolysaccharide or concanavalin A to measure B- or T-lymphocyte mitogenic response. Burn injury impaired peptidoglycan polysaccharide-specific immunoglobulin M synthesis compared with sham (p < 0.05), and this impairment was not restored by the administration of dehydroepiandrosterone (p < 0.05). Furthermore dehydroepiandrosterone did not correct the burn-induced impairments of B- and T-cell mitogenic responses (p < 0.05). Our study demonstrates that in this model the administration of dehydroepiandrosterone in vivo does not correct the impairments of humoral or cellular immunity induced by burn injury.

Effects of a mixture of peptidase inhibitors (amastatin, captopril and phosphoramidon) on Met-enkephalin-, beta-endorphin-, dynorphin-(1-13)- and electroacupuncture-induced antinociception in rats

The effects of a mixture of three peptidase inhibitors (PIs), amastatin, captopril and phosphoramidon, on methionine-enkephalin (Met-enk)-, beta-endorphin (beta-end)-, dynorphin-(1-13) (Dyn)- and electroacupuncture (EA)-induced antinociception were compared in rats. EA was performed by passing electric pulses (3 Hz, 0.1-msec duration, for 45 min) through acupuncture needles inserted into the Hoku-point. The antinociceptive effect was estimated by the hind paw pressure test. The antinociceptive effects of Met-enk and beta-end injected i.c.v. or i.t. and of Dyn injected i.t. were clearly potentiated by the PIs pretreated by the same administration routes as used for the injection of opioid peptides. The antinociceptive effects of Met-enk, beta-end and Dyn injected i.c.v. were also potentiated significantly by i.t.-PIs. PIs injected into the periaqueductal gray (PAG) potentiated EA antinociception. However, the EA effect was not affected by i.t.-PIs and was rather attenuated by i.c.v.-PIs. These results suggest that: i) Met-enk hydrolyzing enzymes are involved in the degradation of not only Met-enk but also beta-end and Dyn in the rat central nervous system; ii) Met-enk and beta-end act on both supraspinal and spinal sites, while Dyn acts only on the spinal site; iii) EA antinociception is mediated by supraspinal Met-enk and/or beta-end; and iv) an anti-opiate peptide system may be activated by EA stimulation, being susceptible to Met-enk hydrolyzing enzymes.

[T cell selection and tolerance induction in the thymus]

T cells play a major role in the immune system. While developing in the thymus, useful T cells are selected for expansion and harmful ones are deleted or inactivated. During this process, it is the T cells themselves which are doing the learning as opposed to the thymus doing the teaching. Both clonal deletion and clonal anergy are mechanisms of tolerance, the former being thymic, and thus central, while the latter is peripheral. Following a signal from the T cell receptor, anergy or deletion is triggered, if there are no co-stimulatory factors. Here, the outcome is determined by binding intensity. However, if the signal from the T cell receptor is accompanied by the required additional co-stimulatory signals, then the T cell is rescued from apoptosis and proliferates.

The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis

BACKGROUND/AIMS

Compared with alcoholic pancreatitis, little is known about the natural history of idiopathic pancreatitis. Two hundred forty-nine patients with alcoholic pancreatitis and 66 patients with idiopathic chronic pancreatitis seen at our institution between 1976 and 1982 were investigated.

METHODS

Records were analyzed retrospectively from the onset of symptomatic disease, and patients were followed up prospectively until 1985. Patients with early-onset (n = 25) and late-onset (n = 41) idiopathic chronic pancreatitis had a median age at onset of symptoms of 19 and 56 years, respectively.

RESULTS

The gender distribution was nearly equal in idiopathic chronic pancreatitis, but 72% of patients with alcoholic pancreatitis were men (P = 0.001 vs. idiopathic). In early-onset idiopathic pancreatitis, calcification and exocrine and endocrine insufficiency developed more slowly than in late-onset idiopathic and alcoholic pancreatitis (P = 0.03). However, in early idiopathic chronic pancreatitis, pain frequently occurred initially (P = 0.003 vs. late and alcoholic) and was more severe (P = 0.04 vs. late and alcoholic). In late-onset idiopathic pancreatitis, pain was absent in nearly 50% of patients.

CONCLUSIONS

There are two distinct forms of idiopathic chronic pancreatitis. Patients with early-onset pancreatitis have initially and thereafter a long course of severe pain but slowly develop morphological and functional pancreatic damage, whereas patients with late-onset pancreatitis have a mild and often a painless course. Both forms differ from alcoholic pancreatitis in their equal gender distribution and a much slower rate of calcification.

[Alteration in ventricular gradient at rest in patients with ischemic heart disease]

The possibility of using alteration in the ventricular gradient (VG) to discern the presence of ischemic heart disease was studied in 30 patients with effort angina pectoris(AP), 21 with vasospastic angina (VSA), 21 with chest pain syndrome (CPS), and 20 healthy volunteers (control). The VG of each consecutive heart beat over a 22-sec interval was calculated by microcomputer from resting Frank-lead X, Y, Z scalar electrocardiograms. The mean values and standard deviations (SD) for the azimuth, elevation, and magnitude of the VG in each group were calculated. The SD and SD/mean ratios for each parameter were used as indices of VG alteration in the groups, and the indices were compared. The SD and SD/mean for the magnitude and elevation of VG were significantly greater in the AP group than in the CPS and control groups. The SD for the azimuth of VG was significantly greater in the AP group than in the CPS and control groups (p < 0.01). The SD and SD/mean for the magnitude of VG were greater in the AP group than in the VSA group (p < 0.01). The SD/mean for the elevation and magnitude of the VG were greater in the VSA group than in the control group (p < 0.01). The SD/mean of the magnitude of the VG was found to be the best index, as it was higher than the upper limit of the control group. The sensitivity and specificity were 80 and 91% (AP vs CPS, p < 0.001), and 43 and 91% (VSA vs CPS, not significant), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)