Surgical treatment of aneurysms of the aortic arch using a simplified selective cerebral perfusion technique

Between April 1989 and October 1993, 35 patients underwent aortic arch reconstruction for aneurysms using cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP). Of the 35 patients, the initial 19 (Group P) consecutively received simplified SCP (partial brachiocephalic perfusion; PBP), and the next 16 (Group S) were consecutively treated with standard SCP. For cerebral protection, blood was supplied to the right axillary artery in Group P, and to the right axillary and the left common carotid arteries in Group S. The aneurysms was aortic dissection in 24 patients, and was secondary to arteriosclerosis in the remaining 11. Partial replacement of the aortic arch together with the ascending aorta was the most commonly performed procedure in both groups. The cardiopulmonary bypass time and the cardiac arrest time were not significantly different between the two groups. The overall cerebral perfusion time was significantly longer in Group S (100 min) than in Group P (65 min); however, when 2 patients with an accidental prolongation of the cerebral perfusion time in Group S were excluded, there was no significant difference in the cerebral perfusion time between the two groups. Early death occurred in 3 patients (15.8%) in Group P, and 2 patients (12.5%) in Group S, however, there were no deaths related to the selective cerebral perfusion technique, and there were no late deaths in either group. Cerebral complications were seen in 1 patient in each group (6.3% vs. 6.7%, not significant). These results suggest that the simplified SCP (PBP) under hypothermic CPB provides as satisfactory cerebral protection as standard SCP, so long as the patency of the circle of Willis is confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of sarcoidosis with middle lobe atelectasis]

We report a case of sarcoidosis complicated by middle lobe atelectasis. A chest radiograph and a chest CT film on admission revealed middle lobe atelectasis and mediastinal lymphadenopathy. Bronchofiberscopic findings showed slit-like stenosis and reddish, edematous mucosal change of the middle lobe orifice. On admission, the serum angiotensin-converting enzyme (ACE) level was within the normal range. However, the ACE level had increased beyond the normal range by 2 months later, histological examination of a specimen from a transbronchial lung biopsy (TBLB) of the middle lobe revealed noncaseating epithelioid cell granulomas. We diagnosed sarcoidosis because of the histological findings from the TBLB and serum ACE elevation. Treatment with predonisolone resulted in remarkable alleviation of middle lobe atelectasis and mediastinal lymphadenopathy. Cases of sarcoidosis with middle lobe atelectasis are rare in Japan.

Role of interleukin-8 (IL-8) and an inhibitory effect of erythromycin on IL-8 release in the airways of patients with chronic airway diseases

To evaluate of the role of interleukin-8 (IL-8), a chemotactic cytokine, in the continuous neutrophil accumulation in the airways of patients with chronic airway disease (CAD) and persistent Pseudomonas aeruginosa infection, we investigated the cell population, IL-8 levels, IL-1 beta levels, tumor necrosis factor (TNF) activities, and neutrophil elastase (NE) activities of bronchoalveolar lavage (BAL) fluids in 17 CAD patients (with P. aeruginosa infections [CAD+PA], n = 9; without any bacterial infections [CAD-PA], n = 8) and 8 normal volunteers. We found significant elevations of neutrophil numbers, IL-8/albumin ratios, and NE/albumin ratios in BAL fluids from CAD patients, in the following rank order: CAD+PA > CAD-PA > normal volunteers. IL-1 beta/albumin ratios were elevated only in CAD+PA, while no TNF bioactivity was detected in BAL fluids. The neutrophil numbers correlated significantly with the IL-8/albumin ratios and NE/albumin ratios in the BAL fluids of CAD patients. When anti-human IL-8 immunoglobulin G was used for neutralizing neutrophil chemotactic factor (NCF) activities in BAL fluids, the mean reduction rate of NCF activities in CAD+PA patients was significantly higher than that in CAD-PA patients. We also evaluated the effects of low-dose, long-term erythromycin therapy in BAL fluids from three CAD+PA and two CAD-PA patients. Treatment with erythromycin caused significant reductions of neutrophil numbers, IL-8/albumin ratios, and NE/albumin ratios in BAL fluids from these patients. To elucidate the mechanism of erythromycin therapy, we also examined whether erythromycin suppressed IL-8 production by human alveolar macrophages and neutrophils in vitro. We demonstrated a moderate inhibitory effect of erythromycin on IL-8 production in Pseudomonas-stimulated neutrophils but not in alveolar macrophages. Our data support the view that persistent P. aeruginosa infection enhances IL-8 production and IL-8-derived NCF activity, causing neutrophil accumulation in the airways and the progressive lung injuries observed in patients with CAD. The clinical efficacy of erythromycin therapy for CAD patients might be partly mediated through a reduced IL-8 production, diminishing neutrophil accumulation and NE release in the airways.

[Unresolved questions in hormonal therapy for prostate cancer]

Although there still are unresolved questions in hormonal therapy for prostatic cancer patients, it has long been considered one of the major therapeutic modalities after the report by Dr. Huggins in 1941. The unresolved questions are: "Can hormonal therapy for prostatic cancer prolong the survival of the patients?" "Can hormonal therapy improve the quality of life of prostatic cancer patients?" "Is complete androgen blockade superior to androgen reduction therapy?" "Is pre-operative hormonal therapy more beneficial than post-operative hormonal therapy?" and "How do we handle relapsed prostatic cancer?" We, urologists, unanimously recognize the beneficial effects of hormonal therapy in most prostatic cancer patients, even in a rather short span. Furthermore, other therapeutic modalities, except radical prostatectomy or radical radiation, can not eradicate cancer cells from patients. We can not treat prostatic cancer patients leading to better outcomes without hormonal therapy. Thus, hormonal therapy is chosen in most of the prostatic cancer patients as a first line therapy. Each type of hormonal therapy for prostatic cancer has specific characteristics, with advantages and disadvantages. We must choose the best hormonal therapy in terms of cost-benefit and quality of life during the therapy.

Transurethral microwave thermotherapy for benign prostatic hyperplasia: patient characteristics in good and poor responders

Transurethral microwave thermotherapy (TUMT) has been shown to produce a clinical benefit in patients with symptomatic benign prostatic hyperplasia. In order to identify the features of the ideal candidate, a retrospective analysis was conducted in 32 patients who were followed for 2 mo or more. Good responders (GR) were defined as having their Siroky peak flow rate (PFR) standard deviation (SD) increase by < 0.5 or a decrease in the International Prostatic Symptom Score (I-PSS) of > 10 (22 patients). Poor responders (PR) were defined as having their PFR SD increase by < or = 0.5 and their I-PSS decrease by < or = 10 (10 patients). The prostate volume, pre-TUMT I-PSS and intravesical opening pressure were significantly greater in the GR group, while there were no significant differences between the 2 groups for the other baseline patient characteristics: age, prostate length, PFR, PFR SD, post-voiding residual volume and quality of life. Concerning the operational parameters, significantly more total energy was delivered to the prostate in the GR group (mean 131 kJ) than in the PR group (mean 101 kJ). Moreover, the 7 patients with anti-androgen therapy pre-TUMT received less total energy and 5 of the 7 were poor responders. These results suggest that patients with apparent obstructive symptoms and with moderate enlargement of prostate could benefit more from this less invasive therapy. Clinical response seems to be dose-dependent and patients with a history of recent anti-androgen treatment may have a less favorable response.(ABSTRACT TRUNCATED AT 250 WORDS)

[Desensitization of the m3-muscarinic acetylcholine-receptor in the smooth muscle and the intracellular signal transduction]

Desensitization of the m3-muscarinic acetylcholine-receptor in the smooth muscle of the digestive tract is discussed together with the changes in intracellular signal transduction. Isolated single cells that show an all-or-none contractile response to acetylcholine were desensitized by treatment with 0.1 mM acetylcholine for 10 min, resulting in an increase in the threshold concentration of acetylcholine for contraction, but without changing any of the binding characteristics. Permeabilized cells showed that the desensitization is via uncoupling between the receptor and G-protein. Secretory cells (rat basophil leukemia-2H3 cells) transfected with human m3-receptor showed desensitization when treated with 0.1 mM carbachol for 30 min. The coupling between the receptor and G-protein was not impaired, but some unknown Ca(2+)-independent mechanism may be involved. Smooth muscle tissue was tested for its time-course of desensitization, and a novel transient resensitization was found at 1 min of incubation with 0.1 mM carbachol. This resensitization, and the desensitization prior to it, were accompanied with changes in binding affinity. However, the affinity was not changed, in parallel with desensitization afterwards, but the positive feedback loop of Ca(2+)-influx caused by alkalization via receptor-stimulation was suppressed. After a 30-min treatment, a Ca(2+)-independent mechanism caused the uncoupling and affinity decrease. Treatment for 3 hr increased the number of binding sites without recovery of the response. The desensitizing process is very diverse to achieve selectivity, but its purpose is in unity.

Serum release of hepatic calcium-binding protein regucalcin by liver injury with galactosamine administration in rats

Whether calcium-binding protein regucalcin, which mainly localizes in liver, is released into the serum by liver injury was investigated in rats administered galactosamine. Galactosamine (25 mg/100 g body weight) was intraperitoneally administered 3 times at 2 h intervals in rats, and the animals were sacrificed at 10, 24 and 48 h after the first administration of galactosamine. Liver regucalcin mRNA levels were clearly reduced at 24 and 48 h after galactosamine administration with estimating for Northern blotting assay. When hepatic regucalcin concentration was estimated by enzyme-linked immunoadsorbent assay (ELISA) with rabbit-anti-regucalcin IgG, liver regucalcin concentration was not significantly altered by galactosamine administration. Serum regucalcin concentration was markedly elevated at 10 and 24 h after the first administration of galactosamine. Serum transaminases (GOT and GPT) activities were significantly increased by galactosamine administration, indicating that liver injury was induced. The present study demonstrates that liver regucalcin is released into the serum by liver injury with galactosamine administration in rats.

ERM family members as molecular linkers between the cell surface glycoprotein CD44 and actin-based cytoskeletons

The ERM family members, ezrin, radixin, and moesin, localizing just beneath the plasma membranes, are thought to be involved in the actin filament/plasma membrane association. To identify the integral membrane protein directly associated with ERM family members, we performed immunoprecipitation studies using antimoesin mAb and cultured baby hamster kidney (BHK) cells metabolically labeled with [35S]methionine or surface-labeled with biotin. The results indicated that moesin is directly associated with a 140-kD integral membrane protein. Using BHK cells as antigens, we obtained a mAb that recognized the 140-kD membrane protein. We next cloned a cDNA encoding the 140-kD membrane protein and identified it as CD44, a broadly distributed cell surface glycoprotein. Immunoprecipitation with various anti-CD44 mAbs showed that ezrin and radixin, as well as moesin, are associated with CD44, not only in BHK cells, but also in mouse L fibroblasts. Furthermore, immunofluorescence microscopy revealed that in both BHK and L cells, the Triton X-100-insoluble CD44 is precisely colocalized with ERM family members. We concluded that ERM family members work as molecular linkers between the cytoplasmic domain of CD44 and actin-based cytoskeletons.

Actin-severing and Ca(2+)-induced reversal of smooth muscle contraction that is independent of Ca2+

1. Intracellular actin filament organization of gastric smooth muscle cells of the guinea pig in primary culture was examined with rhodamine-labelled phalloidin using a confocal laser fluorescence microscope. 2. The resting cells, both in the presence and absence of Ca2+, showed an even distribution of microfilamentous actin fibers. 3. The characteristic image of the stimulated cells with 10 microM acetylcholine in the presence of 1.8 mM Ca2+ was that the actin filaments were located only on the periphery of the cell. 4. The characteristic image of the cells stimulated as above, but in the absence of Ca2+, was that the actin filaments were unevenly distributed in the cell. 5. The characteristic image of the cells stimulated in the presence of 1 microM Ca2+, which inhibits the above contraction, was pultaceous with the actin filaments absent, indicating severing of actin filaments by a Ca(2+)-activated system, such as gelsolin.

Fc epsilon RI-stimulated Ca(2+)-dependent secretion from rat basophilic leukemia (RBL-2H3) cells permeabilized with Staphylococcal alpha-toxin: Fc epsilon RI-operated signals are not mimicked by the actions of GTP gamma S

1. RBL-2H3 cells permeabilized with alpha-toxin responded to dinitrophenol (30-40 mol/mol)-conjugated human serum albumin, as antigen, to secrete [14C]serotonin in the micromolar range of free Ca2+. 2. Calcium ion alone did not cause substantial secretion. 3. Guanosine 5'-O-(3-thiotriphosphate) (GTP gamma S) (100 microM) in combination with Ca2+ produced only negligible [14C]serotonin secretion. 4. GTP gamma S, in the presence of cytochalasin D, caused optimal secretion of [14C]serotonin in a Ca(2+)-dependent manner.

Effect of phorbol 12-myristate 13-acetate on Ca2+-ATPase activity in rat liver nuclei

The effect of phorbol 12-myristate 13-acetate (PMA) on Ca(2+)-ATPase activity in rat liver nuclei was investigated. Ca(2+)-ATPase activity was calculated by subtracting Mg(2+)-ATPase activity from (Ca(2+)-Mg(2+)-ATPase activity. The nuclear Ca(2+)-ATPase activity was significantly increased by the presence of PMA (2-20 microM) in the enzyme reaction mixture; the maximum effect was seen at 10 microM. The PMA (10 microM)-increased Ca(2+)-ATPase activity was not blocked by the presence of staurosporine (2 microM) or dibucaine (2 and 10 microM), an inhibitor of protein kinase. Meanwhile, vanadate (20 and 100 microM) caused a significant reduction in the nuclear Ca(2+)-ATPase activity increased by PMA (10 microM). The present finding suggests that PMA has an activating effect on liver nuclear Ca(2+)-ATPase independent of protein kinase.

Cloning of cDNA for vitellogenin of Athalia rosae (Hymenoptera) and characterization of the vitellogenin gene expression

Athalia rosae (Hymenoptera) was previously shown to have two vitellins (L-Vn and S-Vn) and the two corresponding vitellogenins (L-Vg and S-Vg). A cDNA expression library was constructed from poly(A)+ RNA prepared from adult female fat body cells, and was screened for the vitellogenins by using antisera against the L- and S-Vn, respectively. Examinations of cloned cDNAs show that the vitellogenin gene is transcribed as a single unit, with the 5'-terminal site coding for the S-Vg and the 3'-terminal site for the L-Vg. Nucleotide sequence at the 5'-end suggests the presence of a 16 amino acid-long signal peptide. Deduced amino acid sequence following the signal peptide shows a complete match with up to the 28 N-terminal amino acid sequence determined on S-Vn. The S-L Vg boundary with deduced amino acid sequence matching with 6 N-terminal amino acid sequence determined on L-Vn is also detected. Northern blot hybridization analysis shows that the vitellogenin gene is expressed in the female fat body as a single 6.5 kb mRNA but not in the ovary, and not in the male fat body. Western blot analysis detects a large precursor polypeptide, reacting with the anti-L-Vn and S-Vn antisera, in the adult female fat body.

Amplitude reduction of H-reflex during mental movement simulation in elite athletes

In order to investigate the changes of motoneuron excitability during mental simulation of a voluntary movement (motor imagery; MI), the soleus H-reflex and several activities of autonomic effectors were recorded simultaneously when MI of speed skate sprint was performed. The subjects were seven elite speed skate athletes ranging in age from 18 to 24 years old. They were all skilled in MI, and could imagine full vivid skating movement internally as if they were really exercising. The subjects were awake, relaxed and blindfolded. At first, rest (5 min), positive relaxation (4 min) and concentration periods (2.5 min) were set up. Then, after the previous announcement for the start, MI was initiated by the sound of a signal gun which was recorded by a tape recorder. MIs were continued for each subject from about 36 s to 38 s, and these imaging times were very close to the actual personal best records of each subject. The autonomic effectors represented by skin conductance response (SCR), heart rate (HR), and respiration rate (RSR) became remarkably active during MI in all trials. SCR was increased by 51% on the average. Furthermore, HR and RSR were increased by 57% and 76% respectively, compared with those during resting period. These changes in the autonomic effectors were all significant and were those which were activated in actual movements. The amplitudes of H-reflex were almost all constant before MI initiation. However, the reduction of the H-reflex amplitude arose just after the start and lasted to the end of MI.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment for postinfarction ventricular septal perforation]

Between August 1981 and August 1992, operation for ventricular septal perforation (VSP) after acute myocardial infarction (AMI) was performed in 12 patients and the results were studied. During this period, medical treatment was attempted as a standard therapy for more than two weeks after AMI, followed by operation. However, only four patients received elective operation two weeks after the onset of AMI. Regarding the relationship between the preoperative circulatory status and timing of surgery, elective operative could not be performed in seven patients showing a pulmonary to systemic flow ratio (Qp/Qs) of more than 3.0, while four out of five patients with a ratio of less than 3.0 received operation more than two weeks after the onset of AMI. Two patients with severe right heart failure after the repair of VSP died on table without weaning from the pump. Ten operative survivors were weaned from the pump without any difficulty of hemostasis and intraaortic balloon pumping was removed after operation. However, three patients died of multiple organ failure which had been deteriorating before operation. Postoperative activity improved to New York Heart Association Functional Class I or II in six survivors for the late follow-up period. In the case of high Qp/Qs due to VSP, early operation is recommended to prevent multiple organ failure.

Involvement of Ca(2+)-stimulated adenosine 5'-triphosphatase in the Ca2+ releasing mechanism of rat liver nuclei

The regulatory role of Ca(2+)-stimulated adenosine 5'-triphosphatase (Ca(2+)-ATPase) in Ca2+ transport system of rat liver nuclei was investigated. Ca2+ uptake and release were determined with a Ca2+ electrode. Ca(2+)-ATPase activity was calculated by subtracting Mg(2+)-ATPase activity from (Ca(2+)-Mg2+)-ATPase activity. The release of Ca2+ from the Ca(2+)-loaded nuclei was evoked progressively after Ca2+ uptake with 1.0 mM ATP addition, while it was only slightly in the case of 2.0 mM ATP addition, indicating that the consumption of ATP causes a leak of Ca2+ from the Ca(2+)-loaded nuclei. The presence of N-ethylmaleimide (NEM; 0.1 mM) caused an inhibition of nuclear Ca2+ uptake and induced a promotion of Ca2+ release from the Ca(2+)-loaded nuclei. NEM (0.1 and 0.2 mM) markedly inhibited nuclear Ca(2+)-ATPase activity. This inhibition was completely blocked by the presence of dithiothreitol (DTT; 0.1 and 0.5 mM). Also, DTT inhibited the effect of NEM (0.1 mM) on nuclear Ca2+ uptake and release. Meanwhile, verapamil and diltiazem (10 microM), a blocker of Ca2+ channels, did not prevent the NAD+ (1.0 and 2.0 mM), zinc sulfate (1.0 and 2.5 microM) and arachidonic acid (10 microM)-induced increase in nuclear Ca2+ release, suggesting that Ca2+ channels do not involve on Ca2+ release from the nuclei. These results indicates that an inhibition of nuclear Ca(2+)-ATPase activity causes the decrease in nuclear Ca2+ uptake and the release of Ca2+ from the Ca(2+)-loaded nuclei. The present finding suggests that Ca(2+)-ATPase plays a critical role in the regulatory mechanism of Ca2+ uptake and release in rat liver nuclei.

Nonsurgical correction for thrombosis of a St. Jude Medical tricuspid prosthesis: report of a case

A 43-year-old woman with rheumatic heart disease underwent replacement of the aortic, mitral, and tricuspid valves using three SJM prostheses. Despite adequate warfarin therapy, routine cineradiography performed on the 40th postoperative day showed one of the leaflets of the tricuspid prosthesis to be "stuck" in the semiclosing position. A thrombosis of the tricuspid prosthesis was successfully treated with a urokinase infusion and mechanical thrombolysis using a pacemaker, following which normal valve function was restored.

[Intractable bacterial infection--review]

The factors involved in the mechanism of intractable bacterial infections are systemic, local and iatrogenic compromised conditions which mean the deficiency of host defence. From our results, especially on diffuse panbronchiolitis with Pseudomonas aeruginosa, we have learned about the harmful effects of destroyed neutrophils accumulated in bronchial and bronchiolar trees. Although low doses of erythromycin therapy is effective for intractable DPB. There are many evidences on the mechanisms for this treatment reported by Japanese researchers. We also reported our data of IL-8 level in BALF after this treatment. Bacterial factors of intractable processes are also important.

False aneurysm of the ascending aorta with fistula to the right atrium. Noninvasive diagnosis by computed tomographic scan and two-dimensional echocardiography with successful repair

A 57-year-old Japanese man presented with symptoms of congestive heart failure 9 years after aortic valve replacement. On auscultation, a continuous murmur was heard at the left lower sternal border. Chest radiograph showed moderate cardiomegaly and a widened upper mediastinum. Computed tomographic scans showed a dilated ascending aorta, in which there was no intimal flap, and also showed a large mass which compressed the right atrium. Two-dimensional Doppler echocardiography revealed abnormal continuous blood flow directed from the dilated ascending aorta to the right atrium and no periprosthetic leak. At operation, a false aneurysm of the ascending aorta which originated from the aortotomy suture line and a fistula from the aorta to the right atrium were confirmed. The fistula was closed with pledgeted sutures, and the ascending aorta was replaced with a collagen-coated double woven velour dacron graft. The patient recovered uneventfully. Computed tomographic scan and two-dimensional echocardiography are complementary techniques for reliable non-invasive assessment of the complexity of an aortic aneurysm.

Stereotactic fine needle aspiration of mammographic lesions

Stereotactic fine needle aspiration biopsy (FNAB) is being offered at many centers across the United States in lieu of open surgical biopsy for nonpalpable mammographic lesions. To determine how accurate this procedure is in a community hospital, the authors performed stereotactic FNAB of 62 nonpalpable mammographic lesions using Siemens upright stereotactic equipment. FNAB was immediately followed by hook wire localization and open biopsy. Ten lesions were histologically malignant. Seven of these had been identified cytologically as atypical, suspicious or malignant. Three carcinomas were undetected by FNAB, for a sensitivity rate of 70 percent. There were no false-positive FNAB diagnoses. Three different radiologists performed the FNAB and localizations. Our results were insufficiently sensitive to be able to offer stereotactic FNAB to patients in lieu of open surgical biopsy. We are currently planning to evaluate the dedicated stereotactic prone biopsy equipment to compare the results of needle core biopsies with subsequent hook wire localization and open biopsy.

Surgical treatment for acute aortic dissection and coexistent degenerative aortic aneurysm. Report of three cases

Acute aortic dissection occurring in an aorta previously afflicted with degenerative, atherosclerotic is unusual. We report three cases with acute aortic dissection (DeBakey type III-b) occurring in an aorta which had a preexistent degenerative aortic aneurysm. Two of the three patients had acute aortic dissection originating from the distal end of the degenerative aneurysm, and the remaining one had the acute aortic dissection and degenerative aneurysm at different segments of the aorta. Since the risk of rupture is likely to be much higher in the patients with coexistence of acute aortic dissection and degenerative aortic aneurysm, compared with patients with DeBakey type III acute aortic dissection alone, we believe that a prompt and aggressive surgical approach is essential to prevent rupture, and that digital subtraction angiography (DSA) is more helpful in making a correct diagnosis and in helping to decide surgical procedures and supportive methods than other noninvasive diagnostic procedures.

Phase I/II trial of preoperative thermoradiotherapy in the treatment of urinary bladder cancer

Between April 1984 and September 1988, preoperative radiotherapy or thermoradiotherapy was administered to 49 patients with bladder cancer (T1-4N0M0; UICC classification, 1987). Twenty-one patients were preoperatively treated by radiotherapy alone, with 4 Gy per fraction and three fractions per week to a total dose of 24 Gy (TDF = 53, group 1). The other 28 patients were treated by the same radiotherapy regimen in combination with hyperthermia (group 2). Regional hyperthermia was administered for 35-60 min immediately after irradiation (two sessions per week to a total of four sessions) using an 8 MHz RF capacitive heating device. Group 2 was divided into group 2 (high), in which the average intravesical temperature (T(av)) was > 41.5 degrees C, which was the mean value, and group 2 (low) with a T(av) < 41 x 5 degrees C. Group 2 (high) showed a significantly higher incidence of down-staging and tumour degeneration than both group 1 and group 2 (low). In addition, the local recurrence rate was lower and survival time was longer in group 2 than in group 1, although not significantly so. In particular, the patients with T3-4 or grade 3 bladder cancer in group 2 had a longer average survival than those in group 1, although the difference was not significant. The toxicity associated with hyperthermia was pain during treatment, and complications were not serious.

[Hormonotherapy for prostate cancer]

Since the report by Dr. Huggins, the Nobel prize winner, hormonotherapy has been a predominant treatment modality for prostate cancer for decades around the world because of its anti-cancer effect and simplicity. In the 1960's, the Veterans Administration Co-operative Urological Research Group (VA CURG) in the U.S.A. claimed that synthetic estrogen had significant adverse effects such as cardio-vascular complications, which dissipated the merits of estrogen. They reported that a group of prostate cancer patients who underwent estrogen therapy showed the same survival as a no treatment group. The normal prostate gland is dependent on androgen for its development, growth and function as well as prostate cancer. Ninety to 95% of androgens are synthesized in testicular Leydig cells under the control of the pituitary-gonadal axis, and the remaining androgens come from the adrenal glands. At any point along the axis from the hypothalamus to the prostate cell nuclei, androgen action on the prostate gland can be inhibited. Castration eliminates Leydig cells and estrogen reduces the serum testosterone level by negative feedback to the pituitary gland. Because of the significant side effects of estrogen and the mental injury brought about by castration, LH-RH analogue could have received great popularity. But impotence is still a major consequence of this drug. For less invasive and more economical treatment modalities for prostate cancer, effective anti-androgenic drugs which do not cause impotence must be developed. And the mechanism of androgen independence must be elucidated to obtain a more effective and complete hormonotherapy for prostate cancer.

Obstruction of the St. Jude Medical valve--diagnostic and therapeutic values of cineradiography

Between 1984, and 1992, we observed 8 patients with an obstructed St. Jude Medical (SJM) valve. Of these, 1 had an obstructed SJM valve in the aortic position, 3 in the mitral position, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cineradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cineradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, leaflet function in the obstructed SJM valve was strikingly abnormal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 underwent urgent prosthetic valve replacements after cineradiography and echocardiography were carried out. Thrombolysis using urokinase was performed in 4 patients, and this treatment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat cineradiography. Three of the 4 patients who received thrombolysis showed no significant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function.(ABSTRACT TRUNCATED AT 250 WORDS)

Retroviral reverse transcriptase inhibitory activity in Thai herbs and spices: screening with Moloney murine leukemia viral enzyme

Fifty-seven Thai herbs and spices were examined for their retroviral reverse transcriptase inhibitory activity. All herbs and spices were extracted with hot-water and methanol. Reverse transcriptase inhibitory activity of the extracts was determined by using Moloney Murine Leukemia Virus reverse transcriptase (M-MuLV-RT) reacted with 3H-dTTP and radioactivity measured with a scintillation counter. Eighty-one per cent (46/57) of hot-water extracts and 54% (31/57) of methanol extracts showed inhibitory activities. At a concentration of 125 micrograms/ml, 13% (6/46) of hot-water extracts, namely Eugenia caryophyllus Bullock et Harrison, Phyllanthus urinaria Linn., Terminalia belerica Roxb., Nelumbo nucifera Gaertn., Psidium guajava Linn. and Lawsonia inermis Linn., had a relative inhibitory ratio (IR) over 50%. They showed ratios of 100%, 91%, 75%, 74%, 61% and 60%, respectively. For methanol extracts, only 10% (3/31) had IR values over 50%. They were T. belerica, E. caryophyllus and N. nucifera which exhibited IR values of 83%, 54% and 54%, respectively.

[A case report of miliary tuberculosis with tubercular meningitis diagnosed and followed by polymerase chain reaction method]

We report here a case of miliary tuberculosis with tubercular meningitis in which the polymerase chain reaction (PCR) amplification method was useful for its rapid diagnosis and follow up. A 70 year old male was hospitalized for further examination and treatment of diffuse small nodular shadows on the chest X-ray. After receiving antimicrobial therapy shadows still remained and he gradually lost visual acuity. He had no meningeal signs, and no remarkable finding on cranial CT. Cerebrospinal fluid examination showed increased cell number with predominantly lymphocytes. Cranial MRI (Gd DTPA) showed lateral ventricular ependymitis. Pulmonary tuberculosis and secondary tubercular meningitis were suspected, but we failed to detect microorganisms from the cerebrospinal fluid, gastric juice, sputum, and urine by the conventional method. However, by the polymerase chain reaction amplification method specific DNA fragments of Mycobacterium tuberculosis complex was detected from the cerebrospinal fluid, gastric juice, bronchoalveolar lavage fluid and serum. The final diagnosis of miliary tuberculosis with tubercular meningitis was established. We administered antitubercular drugs and observed the clinical course. He recovered and the polymerase chain reaction showed negative consequences in all samples. The judgement of PCR and the clinical course were compatible and parallel with the clinical course.