[Incidence of uveitis at Tokyo Medical College Hospital]

We reviewed the records of 980 patients with endogenous uveitis who were followed in the uveitis clinic of the Tokyo Medical College Hospital, Department of Ophthalmology. A group of 693 patients examined within a 5-year period from January, 1989 through December, 1993 (Group A) were compared to an earlier group of 287 patients examined within a 3-year period from January, 1982 through December, 1984 (Group B). The incidence of Behçet's disease, intermediate uveitis, and toxoplasmosis showed an apparent decrease. In contrast, the incidence of sarcoidosis and acute anterior uveitis increased. In comparison to Group B, Group A showed an increased number of patients with virus-associated uveitis, toxocariasis, and uveitis caused by fungal infection. The changes observed in the prevalence of certain uveitic diseases in the patient population we followed may be related to changing environment and/or life style, in addition to various advances in diagnostic testing. In the future, the classification of uveitis will become more varied according to the establishment of new concepts.

The preoperative nutritional assessment of surgical patients with hepatic dysfunction

The precise influence of malnutrition on postoperative complications in patients with hepatic dysfunction is not well known. In phase I of the present study, we evaluated the nutritional status of 102 patients with hepatic dysfunction who were admitted for elective hepatobiliary or pancreatic surgery, and a model for the prediction of postoperative complications was developed using a computer-based stepwise regression procedure. The equation for this Prognostic Nutritional Index for Surgery (PNIS) was calculated by [-0.147 x (% weight change) + 0.046 x (% ideal body weight) + 0.010 x (actual triceps skinfold thickness as a % of standard value) + 0.051 x (hepaplastintest)]. In phase II this model was prospectively tested in 182 patients, including 145 with hepatic dysfunction. A total of 18 patients were classified as having a poor prognosis (PNIS < 5) and all of these patients in fact developed postoperative complications: 128 patients were classified as having an intermediate prognosis (5 < or = PNIS < 10), 23 (18.0%) of whom developed postoperative complications, and none of the 36 patients who were classified as having a good prognosis (PNIS > or = 10) developed any postoperative complications. These results demonstrate the importance of performing a thorough preoperative nutritional assessment of patients with hepatic dysfunction as malnourished patients with PNIS < 10 may need preoperative nutritional management, even when their surgical procedures are not major.

Relation of saphenous vein graft obstruction to serum cholesterol levels

OBJECTIVES

To determine the potential of lipid-lowering therapy to reduce saphenous vein graft obstruction, we retrospectively studied the association between graft obstruction and serum cholesterol levels.

BACKGROUND

Atherosclerosis is the major cause of vein graft obstruction. Approximately 50% of grafts are occluded by 10 years after operation. It remains to be established whether lipid control affects long-term graft survival.

METHODS

We carried out a retrospective review of all 284 patients who had undergone coronary artery bypass graft surgery at Juntendo University Hospital between 1976 and 1991 and met the following additional criteria: at least one saphenous vein graft, repeat coronary arteriography at some point after coronary artery bypass graft surgery and a serum cholesterol level > or = 200 mg/dl before operation. Saphenous vein graft obstruction rates were compared among three groups classified by serum cholesterol levels at follow-up arteriography: group I < 200 mg/dl; group II 200 to 239 mg/dl; group III > or = 240 mg/dl. A vein graft was considered obstructed if it was narrowed by > or = 70%.

RESULTS

In group I, 88% of grafts were not obstructed 7 years after operation. The respective rates were 61% in group II and 57% in group III (p < 0.005). This relation was true for vein grafts to the left anterior descending and other coronary arteries.

CONCLUSIONS

Lower serum cholesterol levels are associated with lower rates of vein graft obstruction for up to 7 years. This suggests that cholesterol-lowering therapy may improve long-term saphenous vein graft survival after coronary artery bypass surgery.

A case of allergic aspergillus sinusitis with acute onset

Reports of allergic aspergillus sinusitis have increased in recent years and diagnostic criteria have also come to be established, yet this disease remains a rare disorder. The disorder is generally reported to follow a chronic course. Here we report a case of allergic aspergillus sinusitis with a short morbid term of 3 weeks.

Biphasic and differential expression of cytosolic glutamine synthetase genes of radish during seed germination and senescence of cotyledons

Three structurally distinct cDNA clones for cytosolic glutamine synthetase (GS1) were isolated from libraries prepared from senescing radish cotyledons. Northern blot analysis showed that transcripts from two of the three genes encoding GS1, Gln1;1 and Gln1;3, accumulated in the cotyledons during both dark-induced and natural senescence. Transcripts from the last gene, Gln1;2, remained at a low level during both processes. Transcripts from all three Gln1 genes accumulated in cotyledons of germinating seeds. We infer from these findings that GS1 enzymes function in both germination and senescence to convert ammonium to glutamine to remobilize nitrogen from source to sink organs. We have also examined the pattern of expression of these genes in different tissues. All three genes are expressed in roots. A large amount of transcripts from Gln1;1 accumulated in hypocotyls. Whereas none were transcribed in flowers. During dark-induced senescence of cotyledons, application of inorganic nitrogen delayed chlorophyll degradation. Inorganic nitrogen enhanced the accumulation of Gln1;1 transcripts, but decreased those of Gln1;3. In contrast, application of glutamine promoted yellowing of cotyledons during the dark treatment, and slightly increased the amounts of transcripts from Gln1;3 but decreased those of Gln1;1. Transcription of the three Gln1 genes appears, therefore, to be differentially regulated in radish cotyledons during senescence and germination.

Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma

We have developed a sensitive immunoradiometric assay for PTH-related peptide (PTHrP) using a monoclonal antibody against PTHrP(1-34) and a polyclonal antibody against PTHrP(50-83), with recombinant human PTHrP(1-87) as the standard. The detection limit of the immunoradiometric assay was 0.5 pmol/L, and plasma PTHrP(1-87) concentrations in 110 healthy subjects were 0.8 +/- 0.01 pmol/L, with the upper limit of the normal range being 1.1 pmol/L. Increased circulating PTHrP(1-87) concentrations were demonstrated in all 46 cancer patients with hypercalcemia, but not in patients with primary hyperparathyroidism, chronic renal failure, or hypoparathyroidism. Normalization of serum calcium levels after resection of tumors was shown to correlate well with that of plasma PTHrP(1-87) concentrations in 2 cancer patients. High circulating PTHrP(1-87) levels were also demonstrated in 12 out of 13 hypercalcemic patients with adult T-cell leukemia/lymphoma and in 7 out of 8 hypercalcemic patients with non-Hodgkin's lymphoma especially of B-cell type. These results suggest that PTHrP is a major humoral factor responsible for the hypercalcemia frequently associated with adult T-cell leukemia/lymphoma and also with B-cell lymphoma.

Histopathological study of cardiac rupture following myocardial infarction with and without thrombolytic therapy

The characteristics of cardiac rupture associated with thrombolytic therapy for acute myocardial infarction (MI) were studied in the hearts of 10 autopsy patients, 7 men and 3 women aged 41-80 years (mean 59.9 +/- 13.2 years), who died of rupture of the free wall of the left ventricle following acute MI. The site of rupture was examined histologically and the percentage areas of living myocytes, the processes of organization, necrosis and degeneration, and hemorrhage were compared in four patients who received thrombolytic therapy (group R) and six patients without thrombolytic therapy (group N). There were four pathological findings at the site of rupture: necrosis, neutrophil infiltration, hemorrhage, and evidence of the process of absorption. Group R consisted of two patients with hemorrhage, one with absorption, and one with unsuccessful reperfusion and neutrophilic infiltration. Group N included three patients with necrosis, two with neutrophilic infiltration, and one with hemorrhage. The percentage area involved by necrosis and degeneration was significantly lower in group R than in group N. Therefore, local stress produced by more surviving myocardium around the smaller necrosis area and the weakness of myocardium due to hemorrhage and absorption may provoke cardiac rupture in acute MI patients receiving thrombolytic agent.

Prevention of restenosis after percutaneous transluminal coronary angioplasty by reducing lipoprotein (a) levels with low-density lipoprotein apheresis. Low-Density Lipoprotein Apheresis Angioplasty Restenosis Trial (L-ART) Group

This study was designed to test the hypothesis that high plasma lipoprotein (a) (Lp[a]) levels are associated with an increase incidence of restenosis after angioplasty. Elective transluminal coronary angioplasty was performed in 66 patients (58 men and 8 women) aged 57 +/- 9 years (mean +/- SD). Two days before and 5 days after angioplasty, all patients underwent low-density lipoprotein (LDL) apheresis with a dextran sulfate cellulose column as an Lp(a) absorbent; 39 patients also received 10 mg of pravastatin and 1,500 mg of niacin daily. Restenosis was defined as a recurrent luminal stenosis of > or = 50% in a previously dilated segment. Median Lp(a) levels were reduced from 23.3 mg/dl before apheresis to 10.9 mg/dl after apheresis (p < 0.0001). Angiography performed 2 to 9 months after angioplasty revealed restenosis in at least 1 site in 38% of the 137 control patients and in 32% of the 66 patients who underwent apheresis. Restenosis also occurred in 37% of the patients who underwent apheresis alone and in 28% of the patients who also received pravastatin and niacin in combination with LDL apheresis. The restenosis rate was 21% in the 42 patients whose Lp(a) levels were significantly reduced > or = 50%, and in 50% of the 24 patients whose Lp(a) levels were significantly reduced < 50% (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

High-rate membrane supported aqueous-phase enzymatic conversion in organic solvent

Microporous membranes were used as a support material for enzyme immobilization by a supported aqueous-phase. To test the concept, a model reaction was chosen involving the oxidation of p-cresol by tyrosinase. Tyrosinase was first immobilized in a thin film of water formed on the inner surface of the membrane and then allowed to catalyze p-cresol oxidation in chloroform. By choosing optimal operating conditions, tyrosinase functioned catalytically for more than 6 hours with a stable reaction rate. The reaction rate was highly dependent on water content (water wt./enzyme wt. ratio) and permeation flux. Also, enzyme loading was an important factor for maintaining stable activity. This type of high-rate reactor utilized convective flow through an enzyme immobilized microporous membrane and provided high productivity by reducing mass transport limitations.

High incidence of uterine inversion in mast cell-deficient osteopetrotic mutant mice of mi/mi genotype

Mutations at either W or mi (microphthalmia) loci in the mouse can lead to a deficiency in melanocytes and mast cells. In addition, W mutants can be anemic and sterile, whereas mi mice are osteopetrotic because of a monocyte/macrophage/osteoclast defect. Since c-kit receptor tyrosine kinase is the gene product of the W locus and mi mutation has been suggested to affect the transduction of signals from the c-kit and c-fms receptors, we here examined the effect of mi mutation on fertility. Testes and ovaries from mi/mi mice were histologically normal, and the pattern of c-kit protein expression was not different from that of +/+ mice. Homozygous mutant crosses (mi/mi x mi/mi) were fertile, but inversion of the uterus occurred in 86% of the deliveries. In some cases, the placenta was found still attached to the inverted uterus after delivery. Decidual cells were present and expressed c-kit protein normally in the placenta of mi/mi mice. The inversion was also observed in mi/mi females mated to +/+ males. No uterine inversion was noted when +/mi females were crossed with mi/mi or +/mi males, suggesting that the genotype of the mother but not of the father or fetus is important for the pathogenesis. The numbers and body weights of mi/mi newborns were less than those of +/mi littermates. Mast cells were absent, but c-kit-positive cells were present, in the uterine muscle layers of pregnant mi/mi mice.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of expressed sequences encoded by the human Xq terminal portion using microclone probes generated by laser microdissection

The genes that cause a variety of neurologic and neuromuscular disorders have been mapped to the distal region of Xq. In an effort to isolate genes from this area, a regional genomic library of the distal 30% of Xq was constructed from a single metaphase spread by means of laser microdissection and single unique primer-polymerase chain reaction. Using pooled probes of 1000 clones from the genomic library, human brain cDNA libraries were screened for expressed sequences encoded by this region. From the 250,000 cDNA clones screened so far, 10 nonoverlapping sequences that mapped back to the target portion were isolated. The complete nucleotide sequences of these cDNA clones have been determined. Analysis of the sequences indicates that none has significant similarity to previously characterized primate genes. One sequence mapping to Xq27.3-qter contained an open reading frame of 281 amino acids and was expressed in every tissue tested. This gene, as well as others isolated in this manner, may prove to be a candidate gene for heritable disorders mapping to this region.

Long-term clinical and angiographic follow-up after placement of Palmaz-Schatz coronary stent: a single center experience

The purpose of this study is to evaluate long-term clinical and angiographic follow-up results after placement of the Palmaz-Schatz stent and angiographic follow-up results of repeat interventions for stent restenosis. From June 1990 to September 1993, the Palmaz-Schatz stent was placed in 411 patients, 427 lesions. Follow-up angiography was performed in 307 lesions at 3-6 months and in 189 lesions at 1 year. Palmaz-Schatz stent implantation resulted in 97.2% procedure success and 94.6% clinical success. Stent thrombosis was observed in 2.2%. Angiographic restenosis rate was 16.3% at 3-6 months study. At 1 year study, "new" restenosis occurred only in 2.3%. Minimal lumen diameter did not change between 6 months and 1 year (2.32 +/- 0.51 mm vs 2.30 +/- 0.54 mm). With the mean follow-up interval of 22 +/- 9 months, cardiac event-free survival was achieved in 74.3%. Among 50 lesions with restenosis, stent restenosis occurred diffusely in 15 lesions (30%), focally inside the stent in 22 lesions (44%) and focally at the stent border in 13 lesions (26%). Repeat interventions were performed in 35 lesions. Restenosis at 3 months after repeat intervention was demonstrated in 9 (32.1%) out of 28 lesions restudied. Restenosis rate after repeat intervention for diffuse stent restenosis was significantly higher than that for focal in-stent restenosis (75% vs 7.7%). Palmaz-Schatz stent implantation was associated with a high initial success rate and a low late restenosis rate. Luminal renarrowing did not occur beyond 6 months up to 1 year.

Optimum apportionment of presentation time in visual display

With regard to the better display of visual stimuli, one of the key parameters to match with human short-term memory is the presentation time of the information. We have studied the optimum-apportionment modes of the presentation time of seven Roman alphabet letters sequentially presented to five young males by means of our time-continuous model of short-term memory. These modes are thought to allow for the easiest retention by the short-term memory. The average optimum-apportionment mode, as an average of individual scores of the optimum-apportionment mode, was also obtained. With free-recall experiments using the Roman characters, four constants for the model were determined for the subjects. Then, the theoretical optimum-apportionment modes were calculated using a computer simulation for each subject. With slight modifications of these results, eight types of apportionment modes were obtained. The most efficient mode for the recall of the Roman characters in the free-recall experiment was determined as the optimum-apportionment mode of the individual.

Surgical treatment of hepatocellular carcinoma

The effect of surgical treatment for hepatocellular carcinoma (HCC) was evaluated in 149 resected cases, 83.2% of which were associated with liver cirrhosis. The 3- and 5-year survival rates were 60.1% and 39.4%, respectively. The mortality rate was 4.1%. In patients aged over 70 years, liver cirrhosis was found in 53.3% of cases and the mortality rate was 6.7%. The 3- and 5-year survival rates were 50.8% and 33.9%, respectively. Factors that significantly affected survival for more than 5 years were a tumor size of less than 3 cm, Stage I disease, vp(-), IMo, and diploid type. The 5-year survival rate for patients with a single tumor of 3 cm or less was 54.2%, regardless of the surgical procedure. All 15 patients with a solitary tumor of 2 cm or less (Stage I, small liver tumor) were alive with a 5-year survival rate of 100%. The problem is the treatment of patients with a tumor measuring 3-5 cm in diameter and associated liver cirrhosis, because their prognosis after surgery is the worst. HrS (subsegmentectomy) is the minimal procedure of limited hepatectomy for these cases with postoperative multidisciplinary therapy.

Effectiveness of LDL-apheresis in preventing restenosis after percutaneous transluminal coronary angioplasty (PTCA): LDL-apheresis angioplasty restenosis trial (L-ART)

To investigate the efficacy of reducing plasma lipoprotein(a) (Lp(a)) as well as low density lipoprotein cholesterol (LDL-C) levels on the prevention of restenosis after PTCA, LDL-apheresis was attempted on a total of 54 patients at six institutions. LDL-apheresis using a dextran sulfate cellulose column has been proven to be an effective method for reducing both plasma Lp(a) and LDL-C levels. As a subgroup (apheresis-drug combined group), 29 of the 54 patients were given Pravastatin (HMG CoA reductase inhibitor) and Niceritrol (Nicotinic Acid) in addition to LDL-apheresis to maintain low plasma levels of both Lp(a) and LDL-C through the follow-up period of 5 months after PTCA. Patients whose plasma Lp(a) levels were reduced by more than 50% showed a lower restenosis rate than those whose plasma Lp(a) levels were reduced by less than 50% (21.2% vs. 52.4%, P = 0.0179), especially in patients with high plasma Lp(a) levels above 30 mg/dl where a much lower restenosis rate (15.0%) was observed. Furthermore, in the apheresis-drug combined group, the restenosis rate was 11.8% regardless of baseline plasma Lp(a) levels, including even those below 30 mg/dl. In conclusion, in patients with high plasma Lp(a) levels, a greater than 50% reduction in Lp(a) levels by LDL-apheresis is effective in preventing restenosis after PTCA. If the plasma Lp(a) reduction rate is greater than 50%, LDL-apheresis combined with lipid-lowering drugs such as niceritrol and pravastatin seems to be more effective, even in patients with low plasma Lp(a) levels.

Acute myocardial infarction induced by ergonovine administration for artificially induced abortion

Acute myocardial infarction after artificially induced abortion is an uncommon event because such patients are usually young females and are not usually subject to atherosclerosis. This report describes two premenopausal females who developed acute myocardial infarction after administration of ergot derivatives which were used following abortion. Coronary arteries in both cases were angiographically normal. Both patients were smokers. We concluded that the ischemic event was caused by coronary vasospasm which was precipitated by the acute administration of ergot derivatives.

Non-radioisotopic quantitative RT-PCR to detect changes in mRNA levels during early mouse embryo development

We developed a non-radioisotopic quantitative RT-PCR method with high sensitivity and reproducibility. The results of this RT-PCR were in agreement with those of the Northern blot analysis. We measured the mRNA levels of beta-actin, transferrin receptor, and two cell cycle-related genes, cyclin B and cdc25, in early mouse embryos by the RT-PCR. In late two-cell stage embryos, beta-actin, transferrin receptor and cyclin B mRNA levels were 10-20% of those in MII stage oocytes. In contrast, the cdc25 mRNA levels were not different between these stages. When we cultured mouse embryos, the presence of an RNA polymerase inhibitor, alpha-amanitin, in the medium did not affect the mRNA levels at the two-cell stage, indicating that most of the detected mRNAs in two-cell embryos were maternally derived. These results suggest that the rate of mRNA degradation is different between cyclin B and cdc25 during early embryogenesis.

Serial angiographic follow-up after Palmaz-Schatz stent implantation: comparison with conventional balloon angioplasty

OBJECTIVES

Serial angiographic follow-up study was designed to evaluate the temporal mode of lumen diameter changes after Palmaz-Schatz stent implantation, and the results were compared with those from a cohort of patients undergoing balloon angioplasty.

BACKGROUND

Restenosis remains a major limitation of balloon angioplasty. The Palmaz-Schatz balloon expandable coronary stent is now under clinical investigation to evaluate its efficacy in preventing restenosis.

METHODS

Serial angiographic follow-up study was performed the day after stent implantation and at 1, 3 and 6 months after the procedure. The stent group consisted of 96 patients who had 97 lesions with a single stent. A cohort of 179 patients with 192 lesions were selected as the balloon group by the criteria of final balloon size > or = 3 mm and lesion length < 20 mm.

RESULTS

A significantly larger lumen diameter was obtained immediately after stent implantation (2.9 +/- 0.4 mm [mean +/- SD] in the stent group vs. 2.1 +/- 0.5 mm in the balloon group, p < 0.001). At 3 to 6 months of follow-up, a significantly larger lumen diameter was maintained in the stent group (2.2 +/- 0.6 vs. 1.5 +/- 0.7 mm, p < 0.001). The late restenosis rate according to a binary definition was significantly lower in the stent group (13% vs. 39%, p < 0.001). Stenosis exacerbation, frequently observed within 24 h after balloon angioplasty, was not found after stenting. Between the next day and 1 month, regression was dominant in the balloon group, whereas progression of stenosis was observed in the stent group. The greatest tendency to restenosis was observed in both groups between 1 and 3 months after the procedure. Between 3 and 6 months, significantly greater diameter loss was found in the stent group.

CONCLUSIONS

The Palmaz-Schatz stent was effective in reducing the restenosis rate in this highly selected cohort of patients. Reduction in restenosis rate was dependent on a larger lumen obtained immediately. Late loss of diameter was significantly greater after stenting. The restenosis rate after stenting should be evaluated by follow-up angiography at 6 months rather than at 3 months, which is adequate after conventional balloon angioplasty.

Mucin-producing cystic adenocarcinoma of the pancreas, a case report, 7-year follow-up period

Mucinous ductal ectasia is recognized as a premalignant disease. Recently, we have encountered a patient with a mucin-producing neoplasm of the pancreas, who had been under periodic observation for chronic pancreatitis for 7 years prior to diagnosis of carcinoma and surgery. A 54-year-old male who had been investigated with US, CT and ERCP for chronic pancreatitis developed a mucin-producing ductal carcinoma of the pancreas. In this case a series of US and ERCP images obtained during the 7-year period had demonstrated insidious growth of the tumor. Pancreaticoduodenectomy was carried out, and the histopathological diagnosis was mucin-producing adenocarcinoma of the pancreas. The patient has been well and has suffered no recurrence for 2 years after surgery.