Effects of nicorandil on left ventricular systolic and diastolic function in patients with hypertrophic cardiomyopathy

Various evidence suggest that myocardial ischemia is a major factor in the progression of hypertrophic cardiomyopathy (HCM). In this study, we investigated the effects of nicorandil on left ventricular (LV) systolic and diastolic function in 12 symptomatic patients with HCM using echocardiography and radionuclide angiography. Nicorandil (6 mg), when administered intravenously, produced no significant changes in any parameter, including LV filling dynamics. However, accelerated LV peak early filling velocity (0.51 +/- 0.13 to 0.59 +/- 0.14 m/sec, p < 0.01), and reduced peak velocity in atrial contraction (0.54 +/- 0.17 to 0.50 +/- 0.15 m/sec, p < 0.05) were observed by Doppler echocardiography after 4 weeks of oral administration of 10 mg nicorandil 3 times daily. This oral administration did not affect heart rate, blood pressure, LV outflow gradient, or LV systolic function. The same favorable results were observed in a wall motion analysis with radionuclide angiography: peak filling rate (PFR) in global LV (3.21 +/- 0.76 to 3.52 +/- 0.87 end-diastolic volume (EDV)/sec, p < 0.02), and apical (4.73 +/- 1.18 to 5.42 +/- 1.55 EDV/sec, p < 0.01) and lateral (4.78 +/- 1.60 to 5.52 +/- 1.51 EDV/sec, p < 0.05) segments was increased, and the time to peak filling rate (TPF) in septal (245 +/- 31 to 203 +/- 40 msec, p < 0.01) and lateral (222 +/- 54 to 193 +/- 34 msec, p < 0.05) segments was reduced. These findings indicate that nicorandil has beneficial effects on LV diastolic function in HCM. These favorable effects may be due to the improvement of subendocardial ischemia.

Endogenous tumor necrosis factor (TNF) production and modification of pathological lesions in experimental Escherichia coli endotoxemia of piglets

We examined the kinetics of tumor necrosis factor (TNF) production induced by Escherichia coli lipopolysaccharide (LPS) in relation to LPS tolerance and endotoxemic lesions of piglets. The plasma of piglets demonstrated cytotoxicity to TNF-sensitive L929 cells between 0.5 and 4 h after inoculation with 200 micrograms kg-1 of LPS. This cytotoxicity was neutralized by anti-bovine TNF serum. These piglets had disseminated intravascular coagulation (DIC) and meningoencephalitis. However, if piglets were first treated with three doses of 40 micrograms kg-1 of LPS, both TNF production and the occurrence of DIC were inhibited when 200 micrograms kg-1 of LPS was inoculated into these piglets. Repetitive inoculation with increasing doses of LPS induced fibrinoid vasculitis, meningoencephalitis and pneumonitis, while hemorrhage was minimal. A very low amount of TNF activity was detected from most of the samples of a piglet after repeated LPS inoculation. These results suggested that severity of the hemorrhagic and thrombotic lesions might relate to the amount of endogenous TNF activity, and that LPS tolerance might relate to inhibition of TNF production.

[Systemic-pulmonary artery shunt using Golaski graft: trial for measurement of the shunt flow]

For the systemic-pulmonary artery shunt operation, the modified Blalock-Taussig shunt was the first choice for procedure in our institution. Since 1990, Golaski knitted Dacron graft (4 or 5 mm in diameter) was used for the prosthesis. Ex-vivo flow calibration of the electromagnetic flow meter (Nihon Koden, MFV-3100) to Golaski graft showed good correlation between the real flow and value measured by the electromagnetic flow meter. Shunt flow was measured in the consecutive clinical fifteen cases. The shunt flow per body surface area of the patient who required additional shunt operation was 721 ml/min/m2 and one patient in whom the congestive heart failure developed after the shunt operation, had the shunt flow of 3,022 ml/min/m2. The adequate shunt flow in these cases was ranged from 745 to 2,820 ml/min/m2 (mean +/- 1 SD, 1,490 +/- 587.8). Therefore we performed the systemic-pulmonary artery shunt operation using Golaski graft to get the shunt flow of 1,000 ml/min/m2 (approximately a third of cardiac index) for the guide of good results.

Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain

At a certain position of trunk flexion, there is a sudden onset of electrical silence in back muscles. This is called "flexion-relaxation (F-R) phenomenon." The goals of this study were (1) to evaluate the relationship between flexion angle and activity of back muscles during flexion movement and (2) to determine what the difference is between healthy subjects and patients with chronic low back pain (CLBP). Twenty-five healthy subjects (13 males and 12 females; average age, 28.3 yr) and 20 patients with CLBP (12 males and 8 females; average age, 34.1 yr) volunteered for this study. The subjects were asked to flex forward maximally from the erect position and to maintain full flexion, followed by returning to the initial upright position. Flexion angle of trunk and hip was measured during the examination. Electromyographic activity of erector spinae was also monitored simultaneously. F-R phenomenon was observed in all healthy subjects before reaching the maximum flexion. Electrical silence continued even after extending the trunk began. In contrast, no patients with CLBP demonstrated F-R phenomenon. A significant difference in muscular activities of erector spinae between the groups was obtained when returning to the erect position from the maximum flexion. Moreover, time lag between trunk and hip movement was much greater in patients than in healthy subjects. This study demonstrated that neuromuscular coordination between trunk and hip could be abnormal in patients with CLBP.

Electromyographic analysis of four techniques for isometric trunk muscle exercises

Posture to avoid hyperextension of the lumbar spine during isometric trunk muscle exercises has been widely recommended. However, there are no common standards for cervical and pelvic alignment during exercises. To investigate the effects of four different techniques regarding cervical and pelvic alignment, electromyographic (EMG) and radiological studies were performed on 30 healthy subjects. The four different postures were: (1) maximally extended neck, (2) neutral neck, (3) maximally flexed neck, and (4) maximally flexed neck with pelvic stabilization through muscle contraction. During flexion exercises, the largest increase in EMG activity in the abdominal muscles was observed with the flexed neck with pelvic stabilization (p < .01). During extensor exercises, the largest increase in EMG activity in the erector spinae was also obtained in the same position (p < .01). An increase of EMG activity in antagonist muscles (eg, erector spinae on flexion, and rectus and oblique muscles on extension) was also greatest with the flexed neck and pelvic stabilization. From the radiographic study, degrees of lumbar lordosis were least with the flexed neck and pelvic stabilization (p < .01). This study showed that neck and pelvic alignment can influence the EMG activity of trunk flexors and extensors during isometric trunk exercises. For isometric trunk muscle exercises, a maximum flexed neck with pelvic stabilization through muscle contraction seems to be the most optimal posture for decreasing the lumbar lordosis and for activating trunk flexors and extensors most effectively.

Concurrent radiotherapy and chemotherapy with protracted continuous infusion of 5-fluorouracil in inoperable esophageal squamous cell carcinoma

PURPOSE

The feasibility of a concurrent chemoradiotherapeutic protocol for patients with inoperable esophageal squamous cell carcinoma was tested.

METHODS AND MATERIALS

Concurrent chemoradiotherapy using protracted low-dose continuous infusions of five-fluorouracil (5-FU; 250-300 mg/m2/24 h) and standard external beam irradiation was given to 28 patients with inoperable esophageal squamous cell carcinoma between November 1991 and June 1993.

RESULTS

For 25 patients receiving a total dose of > or = 60 Gy and concurrent 5-FU infusion for more than 5 weeks, the complete response rate was 52%. Local progression-free rate in this chemoradiotherapy group was significantly higher than the historical controls treated by radiotherapy alone (p < 0.05). A multivariate analysis revealed the treatment scheme (concomitant chemoradiotherapy vs. radiotherapy alone) to be a significant factor in local control (p < 0.01). Swallowing pain (39%), anorexia (39%), and nausea (32%) were the most frequent early reactions. Serious late radiation complications have not been observed.

CONCLUSION

The concurrent chemoradiotherapy using protracted low-dose continuous infusion of 5-FU and standard radiotherapy is an effective and safe method to obtain a local control in inoperable esophageal squamous cell carcinoma.

Uptake site of lansoprazole, a proton pump inhibitor, in human fundic mucosa: possible relevance with fibroblast and Helicobacter pylori

To clarify the mechanism of the effect of lansoprazole in the healing of human gastric ulcer, the uptake sites of lansoprazole were studied using endoscopically biopsied specimens from the margin of the gastric ulcer. The specimens were incubated in a medium containing 3H-lansoprazole for 5 or 15 min., postfixed with 1% osmic acid and embedded in Epon. The semithin or ultrathin sections were made and radioautographic emulsion films were applied by the wire-loop method. 30 days after the incubation, the sections were developed, fixed and observed by light and electron microscopy. As a result, the uptake sites of lansoprazole were accumulated on the fibroblasts located near the tip portion of the gastric mucosa and on the unmyelinated nerve fibers as well as on the parietal cells. Some of the uptake sites were also observed near the plasma membrane of the bacteria in the gastric lumen. From these observations, lansoprazole uptake sites were not only on the parietal cells but on the fibroblasts and the bacteria, suggesting that the effect of lansoprazole was exerted partly through the influence on the mesenchymal cells and Helicobacter pylori-related organisms.

Effect of elevated temperature on experimental swarm rat chondrosarcoma

The effect of hyperthermia on Swarm rat chondrosarcoma viability was investigated in Sprague-Dawley rats. The tumor blocks (0.33 g per block) were heated to 40 degrees C, 50 degrees C, 60 degrees C, 70 degrees C, and 80 degrees C, respectively. Blocks that were not heat treated served as controls. Three heating sessions (10, 20, and 30 minutes) were performed for each heating group. The tumor blocks were transplanted into 4-week-old Sprague-Dawley rats to observe tumor growth. The tumor cells of the control, 40 degrees C (3 time sessions), and 50 degrees C (10 minutes) groups showed little difference from each other microscopically before and 5 weeks after transplantation. Microscopic evidence of cell destruction was observed immediately after hyperthermia in the groups treated at 50 degrees C (20 minutes) and higher. No tumor growth was found in these groups 35 weeks after implantation. Type II collagen, the specific collagen produced by the tumor, was analyzed with the Northern blot hybridization method. The mRNA could not be identified in the groups treated at > 50 degrees C (20 minutes) at 5 weeks after implantation. This study indicates that the growth of Swarm rat chondrosarcoma was retarded at temperatures > 50 degrees C (20 minutes). The Swarm rat chondrosarcoma is a useful model for studying the effects of hyperthermia on malignant tumor growth.

Immunohistochemical studies of PIVKA-II in hepatocellular carcinoma by indirect immunofluorescence

Tissue PIVKA-II was examined in 32 hepatocellular carcinomas and 2 metastatic liver tumors using indirect immunofluorescence, and the results were compared with the size, histological grading and serum PIVKA-II level. The specificity of this method was confirmed by the disappearance of reactivity in PLC/PRF/5 cells after the addition of vitamin K to the culture medium. Positive PIVKA-II staining was observed as a clustered or a single cell pattern only in the HCC nodules, but not in the surrounding cirrhotic tissue. PIVKA-II staining was observed in all HCC groups regardless of histological grade. There was no relationship between PIVKA-II staining and the size of HCC. PIVKA-II was detected immunohistochemically even in small HCC of patients whose plasma PIVKA-II levels were below the detection limit. These results suggest that PIVKA-II production is a specific phenotype of HCC regardless of its histological grading and demonstrate that this immunofluorescent PIVKA-II staining is more sensitive and useful than plasma PIVKA-II assay for the diagnosis of HCC.

Hemoglobin-induced lipid peroxidation in the retina: a possible mechanism for macular degeneration

To investigate a possible link between subretinal hemorrhage and macular degeneration, oxyhemoglobin (HbO2) or methemoglobin (metHb) was incubated with retinal homogenate and unsaturated phospholipid peroxidation was monitored by (a) assay of thiobarbituric acid-reactive substances (TBARS), (b) luminescence originating from an energy transfer of lipid-degraded products to rose bengal, and (c) the decrease in composition of highly unsaturated fatty acids of phospholipids. TBARS formation and rose bengal luminescence in the case of metHb-induced lipid peroxidation were about 1.5 times greater than those in HbO2-induced lipid peroxidation. alpha-Tocopherol, a lipid-soluble antioxidant, and docosahexaenoic acid, a major unsaturated fatty acid, were slightly more rapidly decomposed after a 60-min incubation with metHb than with HbO2 at the same concentration. Atomic absorption analysis revealed that an equal concentration of iron was released from both HbO2 and metHb during incubation with retinal homogenates. The released iron may promote microsomal phospholipid peroxidation in the presence of endogenous ascorbate or NADPH-dependent cytochrome P-450 reductase because ascorbate oxidase and p-chloromercuribenzoic acid (an inhibitor of sulfhydryl enzymes) inhibited metHb- or HbO2-induced lipid peroxidation. MetHb-induced lipid peroxidation in retina was inhibited by KCN or NaN3, which binds to FeIII of metHb. KCN or NaN3 had no effect on HbO2-induced lipid peroxidation, because conversion of HbO2 to metHb, which can proceed in HbO2 incubated with phospholipid liposome, did not occur in retinal homogenates. It is concluded that metHb induces peroxidation of retinal unsaturated phospholipids (1) directly and (2) by releasing iron.

Hypoplastic left heart syndrome with a single coronary artery originating from the pulmonary artery

A newborn male infant with hypoplastic left heart syndrome due to mitral and aortic atresia died on the third day of life. Autopsy revealed a single coronary artery originating from the pulmonary artery, reversed coarctation of the aorta, a coronary sinus type atrial septal defect and stenosis of the left subclavian artery. To our knowledge, hypoplastic left heart syndrome associated with a single coronary artery originating from the pulmonary artery has never been reported in the English or Japanese literature. This may be the first such case.

The usefulness of severe combined immunodeficiency (SCID) mice to study human carcinogenesis

In the present study, we engrafted normal colonic epithelial and histologically diagnosed colonic adenomas from a familial adenomatous polyposis (FAP) patient into severe combined immunodeficient (SCID) mice and subsequently examined them histologically and molecular biologically. Successful engraftment and metastasis was observed. The facts that human normal colonic epithelium and adenomatous polyps can take in SCID mice indicates the possibility that this human SCID mouse system will be useful for investigating the dynamics of human carcinogenesis in various tissues.

Enalapril improves heart failure induced by monocrotaline without reducing pulmonary hypertension in rats: roles of preserved myocardial creatine kinase and lactate dehydrogenase isoenzymes

We investigated the redistribution of myocardial isoenzymes of creatine kinase (CK) and lactate dehydrogenase (LD) in rats with right heart failure induced by monocrotaline and assessed the effect of enalapril, an angiotensin converting enzyme inhibitor. Wistar rats were divided into four groups: (1) control (n = 20), (2) control + enalapril (25 mg/kg/day) (n = 22), (3) monocrotaline (50 mg/kg) (n = 45), (4) monocrotaline (50 mg/kg) + enalapril (25 mg/kg/day) (n = 32). After 4 weeks, the monocrotaline group developed severe pulmonary hypertension and right ventricular hypertrophy with marked decrease in myocardial norepinephrine and increase in both plasma atrial natriuretic peptide and mortality rate (33.3%). The marked decrease in both MM and mitochondrial CK ('creatine shuttle') and the relatively constant BB and MB CK caused the net depression of total CK. The depression of LD1 (aerobic LD) was remarkable compared with the relatively constant total LD. In the monocrotaline+enalapril group, mortality rate (9.4%), cardiac hypertrophy and plasma atrial natriuretic peptide were all significantly reduced and myocardial norepinephrine recovered although pulmonary hypertension was not improved at all. However, myocardial total, MM and mitochondrial CK and LD1 activities were all recovered completely or partially in this group. Thus, enalapril reduced cardiac hypertrophy and failure and improved the prognosis in this model of pulmonary hypertension. This beneficial effect of enalapril was not associated with pulmonary vasodepression but with the inhibition of myocardial isoenzyme redistribution of CK and LD, i.e. the preservation of 'creatine shuttle' and aerobic LD.

Electron microscopic studies of peripheral blood mononuclear cells in chronic type C hepatitis treated with interferon-alpha

Electron microscopic studies of peripheral blood mononuclear cells (PBMC) in chronic type C hepatitis revealed several interesting structures after interferon-alpha (IFN-alpha) therapy. Fifteen of 20 patients were treated with IFN-alpha. Tubuloreticular inclusions (TRI) were observed in only one patient who did not receive therapy. In contrast, TRI were observed in 10 of 15 (66.7%) patients who underwent the therapy for 2 weeks to 6 months. Cylindric confronting cisternae (CCC) were identified in the cytoplasm of PBMC in 4 of 16 (25%) patients who underwent the therapy. CCC were found only after IFN-alpha therapy. The appearance of both TRI and CCC in the PBMC was significantly correlated to IFN-alpha therapy. Although there is little evidence about the morphogenesis of TRI and CCC, these structures may be a host response to IFN-alpha induced by hepatitis C virus infection.

A clinical and immunohistochemical study of papillary adenocarcinoma of the prostate

Clinical and immunohistochemical studies were conducted to evaluate prostatic papillary adenocarcinoma and prostatic papillary hyperplasia. Subjects consisted of 5 cases of papillary adenocarcinoma and 2 cases of papillary hyperplasia. There is no conclusive clinical factor for preoperative diagnosis, but we attach importance to endoscopic findings. PSA, PAP, high molecular weight cytokeratin, and PCNA were evaluated immunohistochemically. PSA became positive in every instance but one--a case of papillary adenocarcinoma which became +/-. PAP was + in all cases, except for 1 case of papillary adenocarcinoma. Basal cells were positive for high molecular weight cytokeratin in 2 cases of papillary hyperplasia but were missing in papillary adenocarcinoma. Although PCNA was free from positive nuclei in papillary hyperplasia, positive nuclei were found in all cases of papillary adenocarcinoma. Considering these immunohistochemical results, papillary adenocarcinoma can be said to originate in the glandular epithelium of the prostate, as does ordinary prostatic carcinoma.

DNA damage produced by exposure of supercoiled plasmid DNA to high- and low-LET ionizing radiation: effects of hydroxyl radical quenchers

Production of DNA damage by exposure to ionizing radiation was measured in two in vitro systems. A supercoiled plasmid of 7.3 kbp was isolated and exposed in an aqueous environment to 60Co gamma rays and JANUS 0.85 MeV fission-spectrum neutrons. Dose responses for the production of single-strand breaks (ssbs) and double-strand breaks (dsbs) were computed from the conversion of the supercoil to its relaxed and linear forms. The relative effectiveness (neutrons:gamma-rays) for destruction of genetic transforming activity of M13 viral DNA was 0.23, close to that for ssb production, in contrast with the situation for biological effects such as lethality, mutagenesis and cellular transformation measured in mammalian cells, where RBEs are > 1. The role of hydroxyl (OH) radicals in DNA damage induction by neutrons was investigated by exposure of plasmid in the presence of known quenchers of this species. Of four quenchers tested, all were able to reduce the yields of both ssbs and dsbs. These findings are consistent with a model for ssb and dsb induction by high linear energy transfer radiation that involves OH radical medication.

[Surgical repair of post-infarction ventricular septal defects--reconstruction with pericardial patch]

Despite improvements in the pre- and postoperative management of patients with post-infarction ventricular septal defects, the results after surgery have been variable. This is in part due to advanced patient age, multi-vessel coronary disease. In addition, resection of the infarcted ventricular septum results in significant compromise in left ventricular function. Since January of 1993, we have used a new technique for the reconstruction of the left ventricle using a single pericardial patch. In this method, which was introduced by Komeda and David in 1990, a single patch is sutured to the interventricular septum and the lateral ventricular wall, excluding the infarcted muscle from the left ventricular cavity. This method was used in the treatment of four patients. There was no bleeding along the suture lines at operation, all of the patients survived. Postoperatively, all four were functional New York Heart Association Class 1. One patient underwent re-operation on the 12th day using the same technique because of a residual shunt. Another two patients had small residual shunts, which spontaneously resolved in 2 to 7 months. Left ventricular function evaluated 1 month after the operation utilizing cardiac catheterization revealed a mean stroke volume index of 40 (range: 32-45 ml/m2, and a mean left ventricular ejection fraction of 71 (range: 70-73%). An excellent functional outcome has thus been achieved with the reconstruction of post-infarction ventricular septal defects using a single pericardial patch.