Noninvasive Three-dimensional Assessment of Single Molecular Crystals Using Multiphoton Microscopic Observation and Their Deformation-induced Emission Characteristics

Distinguishing the luminescence contribution from the surface and bulk of a crystal is a long-standing challenge in crystal materials. Herein, three-dimensional, multiphoton, luminescence microscope imaging of the elastic molecular single crystal 1,4-bis(4-methylthien-2-yl)-2,3,5,6-tetrafluorobenzene, was conducted. Further, the luminescence contribution from the surface and bulk of the crystal was experimentally distinguished. Strong luminescence was observed only from the surface of the crystal, while the bulk did not emit strongly. Furthermore, the surface and bulk luminescence behavior responded well to the mechanical shape change of the crystal; i.e., strong luminescence was observed for the elongated side of the crystal.

Regulation of dihydropyrimidine dehydrogenase and pyrimidine nucleoside phosphorylase activities by growth factors and subsequent effects on 5-fluorouracil sensitivity in tumor cells

Dihydropyrimidine dehydrogenase (DPD) and pyrimidine nucleoside phosphorylase (PyNPase) are the first and rate-limiting enzymes that regulate 5-fluorouracil (5-FU) metabolism, and tumoral DPD activity appears to be a promising predictor of 5-FU sensitivity. However, the regulatory mechanisms determining these enzyme activities have not been fully understood. We investigated the biological effects of epidermal growth factor (EGF) and transforming growth factor (TGF)-alpha on cell growth and tumoral DPD and PyNPase activities, and the subsequent effects on 5-FU sensitivity in uterine cervical carcinoma SKG-IIIb cells. The treatment of tumor cells with EGF or TGF-alpha resulted in a concentration-dependent increase in tumor cell growth and PyNPase activity, whereas tumoral DPD activity was inhibited. Their stimulatory effects on tumor cell growth correlated well with PyNPase activity, but were inversely related to DPD activity (P < 0.01). 5-FU sensitivity of tumor cells increased in the presence of EGF or TGF-alpha. These growth factors were shown to stimulate the first, rate-limiting enzyme activity in 5-FU anabolism and to inhibit that in 5-FU catabolism, leading to enhancement of the antiproliferative action of 5-FU at achievable therapeutic levels. The tumor environmental factors, EGF and TGF-alpha, may act as intrinsic regulators of DPD and PyNPase activities that affect the 5-FU sensitivity of individual tumors.

Studies on the carcinogenicity of potassium iodide in F344 rats

A chronic toxicity and carcinogenicity study, in which male and female F344/DuCrj rats were given potassium iodide (KI) in the drinking water at concentrations of 0, 10, 100 or 1000 ppm for 104 weeks, and a two-stage carcinogenicity study of application at 0 or 1000 ppm for 83 weeks following a single injection of N-bis(2-hydroxypropyl)nitrosamine (DHPN), were conducted. In the former, squamous cell carcinomas were induced in the salivary glands of the 1000 ppm group, but no tumors were observed in the thyroid. In the two-stage carcinogenicity study, thyroidal weights and the incidence of thyroid tumors derived from the follicular epithelium were significantly increased in the DHPN+KI as compared with the DHPN alone group. The results of our studies suggest that excess KI has a thyroid tumor-promoting effect, but KI per se does not induce thyroid tumors in rats. In the salivary gland, KI was suggested to have carcinogenic potential via an epigenetic mechanism, only active at a high dose.

Low susceptibility of Long-Evans Cinnamon rats to N-butyl-N-(4-hydroxybutyl)-nitrosamine-induced urinary bladder carcinogenesis and inhibitory effect of urinary copper

We studied the susceptibilities to N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN)-induced urinary bladder carcinogenesis of male Long-Evans Cinnamon (LEC), F344 and Long-Evans Agouti (LEA) rats. Male rats (n=21) were given 0.1% BBN in their drinking water from week 6, 8 and 10 for one week, and killed in week 56. The incidences of transitional cell tumors (papillomas plus carcinomas) in BBN-treated LEC and F344 rats were 12% and 76%, respectively (P<0.001, experiment 1), and those in LEC and LEA rats were 11% and 95%, respectively (P<0.001, experiment 2). When male LEC and F344 rats were given 0.1% BBN in their drinking water for 7 days, the intake of BBN and the urinary concentration of its active metabolite, N-butyl-N-(3-carboxypropyl)nitrosamine (BCPN), were higher in the LEC rats (P<0.01). The urinary pHs of untreated LEC and F344 rats were similar between week 6 and 30. The urinary copper concentration was lower in LEC rats before jaundice than in F344 rats, but its concentrations in 28- and 50-week-old LEC rats were 1.7 and 2.3 times those in F344 rats. In a two-stage carcinogenesis study using F344 rats, i.p. injections of cupric nitrilotriacetate increased urinary copper excretion, and inhibited BBN-induced bladder carcinogenesis. In a two-stage carcinogenesis study using LEC rats, oral administration of D-penicillamine decreased urinary copper excretion, and increased BBN-induced bladder cancer, although the difference was not significant. These data show that LEC rats are resistant to bladder carcinogenesis and suggest that urinary copper has a significant role in their resistance.

COLLABORATIVE WORK TO EVALUATE TOXICITY ON MALE REPRODUCTIVE ORGANS BY REPEATED DOSE STUDIES IN RATS : 13)EFFECTS OF A SINGLE ORAL DOSE OF CYCLOPHOSPHAMIDE

As part of a collaborative effort to evaluate whether effects on male reproductive organs of chemicals can be detected within two-week in toxicity studies, eight-week-old male Sprague-Dawley rats were given a single oral administration of 100 mg/kg of Cyclophosphamide (Cp), and sacrificed at 1, 3, 7 and 14 days thereafter. The numbers of seminiferous epithelial cells were counted in the seminiferous tubules of stages II-III, V, VII and XII of the spermatogenic cycle. Animals showed decreased spermatogonia at Day 3, decreased spermatogonia and preleptotene spermatocytes at Day 7, and decreased spermatogonia and zygotene spermatocytes at Day 14. We also detected decrease of zygotene spermatocytes on careful routine/traditional histopathological examination at Day 14. These results suggest that the testicular toxicity of Cp can be detected within two weeks after treatment with a sufficient dose in rats.

Effect of CABG on coronary flow reserve in atresia of the left coronary ostium

We evaluated the change of coronary flow reserve using a Doppler guidewire before and after coronary artery bypass grafting to assess the coronary hemodynamic effect of surgical revascularization in a 13-year-old boy with congenital atresia of the left coronary ostium, which is one of the rarest of the congenital coronary anomalies. Coronary flow reserve in the right coronary artery and left anterior descending artery increased significantly after coronary revascularization, and a microvascular bed developed in the left anterior descending artery.

Effects of D-galactosamine hydrochloride and partial hepatectomy on spontaneous hepatic injury and hepatocarcinogenesis in Long-Evans Cinnamon rats

To examine the effect of nongenotoxic chemicals on hepatocarcinogenesis in Long-Evans Cinnamon (LEC) rats, we gave 6-week-old male and female LEC rats (n = 18) weekly subcutaneous injections of D-galactosamine hydrochloride (GalN, 300 mg/kg) in 0.9% NaCl or only 0.9% NaCl for 50 weeks, and killed them in week 62. GalN-treated male rats unexpectedly showed no lethal necrotizing hepatitis. GalN treatment increased the incidence of cholangiofibrosis in males and its severity in females, but did not cause significant increases of hepatocellular tumors in either sex. GaIN treatment increased the 5-bromo-2'-deoxyuridine (BrdU)-labeling index of hepatocytes and plasma hepatocyte growth factor, and accelerated megalocytic alterations without reduction of the hepatic copper concentration. Next, male and female LEC rats were subjected to two-thirds partial hepatectomy (PH) or sham hepatectomy in week 8 (n = 12) or in week 14 (n = 9), and killed in week 62. PH in week 14 inhibited lethal hepatitis, but PH in week 8 was less effective. PH reduced the hepatic copper concentration to half that of controls. The present data suggest that induction of hepatocyte regeneration by repeated injections of GalN, or by PH just before the onset of jaundice has a significant effect in prevention of hepatic injury of LEC rats, but not enhancement of spontaneous hepatocarcinogenesis.

Role of copper accumulation in spontaneous renal carcinogenesis in Long-Evans Cinnamon rats

Spontaneous renal cell tumors in totals of 223 male and female Long-Evans Cinnamon (LEC) rats of 51-120 weeks old, 157 male F344 rats of 51-120 weeks old, and 14 male Long-Evans Agouti (LEA) rats of 51-70 weeks old were examined histologically. The incidences of renal cell tumors increased with age in male and female LEC rats, but no tumors developed in F344 or LEA rats. Dilated atypical tubules of the kidneys were observed at high incidence in aged LEC rats. Copper staining of LEC rat kidneys showed a positive reaction in proximal tubules of the cortex and the outer stripe of the medulla. The renal copper concentration of LEC rats reached a peak in the period of necrotizing hepatitis with renal tubular necrosis, and was higher than that in F344 rats for up to 106 weeks. In contrast, the renal iron concentration of LEC rats was lower than that in F344 rats except in the period of necrotizing hepatitis. Long-term treatment of LEC rats with D-penicillamine, a copper-chelating agent, inhibited accumulation of copper, but not iron, in the kidneys, and inhibited the development of karyomegaly of proximal tubules and dilated atypical tubules. These results suggest that persistent copper accumulation after toxic necrosis of tubules is the major cause of spontaneous renal carcinogenesis in LEC rats.

[Effects of prophylactic antibiotic agent on interleukin-6 level in open chest surgery--comparison between imipenem and flomoxef]

Cytokines are known to increase in the patients subjected to open chest surgery. Those patients are usually administered with antibiotic agents for prophylaxis, while some of antibiotic agents might yield significantly higher level of cytokines than other agents especially in patients suffering from severe infections. It is believed that imipenem may yield lower interleukin-6 (IL6) level than cephem antibiotics. To study whether such difference could be observed in the patients who show no sign of severe infections, a total of 13 patients underwent scheduled open chest surgery were allocated at random into two groups, the imipenem-group and the flomoxef-group. The cytokine levels of the patients in the two groups were compared, while the prophylactic administration of imipenem or flomoxef. In both groups, IL6 increased immediately after the operation while endotoxin remained unchanged. Thereafter IL6 decreased gradually in both groups, however, the decrease of IL6 in the imipenem-group was faster and greater than the flomoxef-group resulting in the significantly lower level of IL6 on the 4th day after operation. One week after the operation, there existed no difference in the IL6 levels between these two groups. In conclusion, it was suggested that, depending on the choice of a prophylactic antibiotic agent, some invasive burden could be added to those patients underwent open chest surgery, a certain number of whom would develop severe infection.

Induction of squamous cell carcinomas in the salivary glands of rats by potassium iodide

In a 2-year carcinogenicity study of potassium iodide (KI) in F344/DuCrj rats, squamous cell carcinomas (SCCs) were observed in the salivary glands of 4/40 males and 3/40 females receiving 1000 ppm KI in the drinking water. Ductular proliferation with lobular atrophy was observed at high incidence in the submandibular glands of the high-dose animals, and squamous metaplasia was frequently evident within the proliferative ductules and the larger interlobular ducts. A transition from metaplasia to SCC was apparent. The results suggest that squamous metaplasia in proliferative ductules, occurring secondarily to lobular impairment induced by KI, may develop into SCCs via a non-genotoxic, proliferation-dependent mechanism.

UDP-GT involvement in the enhancement of cell proliferation in thyroid follicular cell proliferative lesions in rats treated with thiourea and vitamin A

The mechanisms underlying enhanced cell proliferation in thyroid proliferative lesions of rats simultaneously treated with large amounts of vitamin A (VA) and thiourea (TU) were investigated. Male F344 animals were initiated with N-bis(2-hydroxypropyl)nitrosamine (2800 mg/kg body weight, single s.c. injection). Starting 1 week later, groups received water containing 0.2% TU (TU group), diet containing 0.1% VA (VA group), both 0.2% TU and 0.1% VA (TU + VA group) or tap water/basal diet without supplement (control group) for 10 weeks. The serum levels of triiodothyronine (T3) and thyroxine (T4) were decreased and the thyroid stimulating hormone (TSH) levels were elevated in the TU and TU + VA groups, with the degree of change being significantly greater in the combined treatment group. The induction of P450 isoenzymes by TU was not enhanced by VA supplementation, but uridine diphosphate glucuronosyltransferase (UDP-GT) activity in the liver was significantly increased in the TU + VA group compared to the TU group. Thyroid weights were increased in both the TU and TU + VA groups, this being more pronounced with VA supplementation. Thyroid follicular cell hyperplasias and neoplasias were induced to similar extents in both TU treated groups, but their cell proliferation appeared to be increased by the VA supplementation. The results of the present study suggest that enhanced cell proliferation is due to increased TSH stimulation, resulting from the decrease in serum T3/T4 levels brought about by induction of liver UDP-GT activity with the combined action of TU + VA as well as inhibition by TU of thyroid hormone synthesis in the thyroid.

In vitro combination effect of 5-fluorouracil and cisplatin on the proliferation, morphology and expression of Ki-67 antigen in human gastric cancer cells

The combination effect of 5-fluorouracil (5-FU) and cisplatin was examined in terms of the proliferation, morphology and expression of Ki-67 antigen, and propidium iodide (PI) staining using four cultured human gastric cancer cell lines, and we assessed how such activity was affected by the exposure time and the timing of treatment. MKN-1, MKN-28, MKN-45 and MKN-74 cells were exposed to various concentrations of 5-FU for 72 h and cisplatin for 8 or 72 h. At IC50, MKN-28 cells were more sensitive to 5-FU than other cell lines, whereas MKN-1 and MKN-45 cells were more sensitive to cisplatin than other cell lines. The cell growth-inhibitory activity of cisplatin was found to be 'area under the curve' dependent. When 5-FU and cisplatin were combined simultaneously, the combination effect was higher than that of 5-FU or cisplatin alone. On the other hand, when cisplatin was applied before 5-FU, there was no potentiation of the cell growth-inhibitory activity by combination treatment. In 5-FU-treated MKN-74 cells, the size, morphology and PI staining of nuclei were almost the same as those of the untreated cells, and the expression of Ki-67 antigen was less than that of the untreated cells. In cisplatin-treated MKN-74 cells, the size of cells and nuclei was larger than that of the untreated cells and fragmentation of nuclei was observed. The expression of Ki-67 antigen was less than the untreated cells but more than that of 5-FU-treated cells. In the cells treated with 5-FU and cisplatin in combination, the above changes were an intermediate of those of 5-FU-treated cells and cisplatin-treated cells. In conclusion, the cell growth-inhibitory activity of 5-FU and cisplatin against gastric cancer cells was potentiated by the combined treatment with 5-FU and cisplatin simultaneously, but not with cisplatin followed by 5-FU.

Effects of organic anions and bile acid conjugates on biliary excretion of LTC4 in the rat

Biliary organic anion excretion is mediated by an ATP-dependent primary active transporter, so-called canalicular multispecific organic anion transporter (cMOAT). On the other hand, a multiplicity of canalicular organic anion transport has been suggested. Therefore, to examine the substrate specificity of cMOAT using inhibition of excretion of [3H] LTC4-derived radioactive products in the bile as a marker, we examined the effects of various organic anions and bile acid conjugates on the biliary excretion of LTC4 in rats. Biliary excretion of the metabolites of [3H] LTC4, which was injected via the femoral vein, was markedly inhibited by sulfobromophthalein-glutathione, taurolithocholate-3-sulfate, and ursodeoxycholate-3-O-glucuronide. In contrast, dibromosulfophthalein and cefpiramide slightly inhibited, and pravastatin, taurocholate, and 3,7-sul-UDC did not affect biliary LTC4 excretion. Furthermore, vinblastine and phenothiazine, a P-glycoprotein substrate and inducer, did not affect biliary LTC4 excretion. Among various organic anions and bile acid conjugates, LTC4, sulfobromophthalein-glutathione, taurolithocholate-3-sulfate, and ursodeoxycholate-3-O-glucuronide may be good substrates for cMOAT.

[A case of successfully treated fungal tricuspid infective endocarditis with repeated pulmonary embolism]

A case of successfully treated fungal tricuspid infective endocarditis with repeated pulmonary embolism is reported. A 60-year-old man had received along term intravenous hyperalimentation for the treatment of the complication after hepatopancreatoduodenectomy, associated with Candida sepsis. He was once discharged, successfully treated with antifungal agents. But he was readmitted to our hospital due to fever, cough and chest pain. Blood culture revealed Candida tropicalis. Pulmonary scintigraphy and angiography revealed multiple infarcts of the right lung, and echocardiography showed vegetation on the tricuspid valve. Because of exacerbation of shortness of breath, tricuspid valvuloplasty and thromboembolectomy in the pulmonary arteries was performed. Postoperative course was uneventful and he had a marked improvement of dyspnea after operation.

Lack of carcinogenicity of cyanoguanidine in F344 rats

The carcinogenicity of cyanoguanidine, a compound used in the production of melamine, guanidine salts and guanamine derivatives, was examined in male and female Fischer 344 rats fed CRF-1 pulverized diets containing 0, 2.5 and 5% cyanoguanidine for up to 2 yr. The rats were randomly allocated to three groups, each consisting of 50 males and 50 females. The mean body weight gains in both sexes of the 5% group and in females of the 2.5% group were significantly lower than the control values after wk 1 of treatment. No other signs of toxicity were seen in any of the rats throughout the treatment period. Histopathologically, various tumours developed in all groups, including the control group, but these were all similar to those known to occur spontaneously in this strain of rats, and no toxicologically significant increase was found for any lesion type in the treated groups. On the basis of these results, it is concluded that cyanoguanidine exerts no carcinogenic potential in F344 rats when administered for up to 2 yr under the conditions of the present study.

[Clinical problems in surgical treatment for active infective endocarditis]

From October, 1982, to December, 1995, 22 patients with active infective endocarditis underwent surgical treatment. Of 22 patients, 12 patients (group P) demonstrated microorganisms on blood culture obtained at the operation and/or in the excised valve, and 10 patients (group N) showed acute inflammatory reaction in the excised valve microscopically. Operative mortality in group P was significantly higher than that in group N (50% versus 0%,p < 0.01). Especially in group P, five of six patients (83%) with uncontorolled infection for more than eight days died within 30 days of operation. This showed that prolonged preoperative periods of uncontrolled infection influenced the surgical outcome of active infective endocarditis. In conclusion, patients who do not promptly response to antibiotic treatment must be considered for early operation within seven days of the diagnosis of infective endocarditis to decrease operative mortality. The plasma level of CRP and definition of sepsis may be useful as indicators of uncontrolled infection.

[Surgical treatment for ascending aortic aneurysm using a transthoracic left ventricular venting]

Three patients with ascending aortic aneurysms underwent graft replacement using deep hypothermic circulatory arrest with continuous retrograde cerebral perfusion. In all three cases, preoperative radiographic examination revealed that the aneurysm was large, thin, and adherent to the back of the sternum. For this reason, left ventricular venting was performed through a left thoracotomy before median sternotomy, to decrease both the risk of rupture of the aneurysm and the difficulty of cannulation. This new method, called transthoracic left ventricular venting, was very useful for performing a median sternotomy under hypotensive and hypothermic conditions adequate to reduce the risk of rupture and to manage any rupture immediately through deep hypothermic circulatory arrest.

[Renal autotransplantation for dissecting aneurysm]

Out of twenty-five patients operated on for dissecting aneurysm in our institution since January 1991, four patients had autotransplantation of the kidney. The renal autotransplantation and the segmental replacement of the descending aorta with the prosthesis were done at the same time in three of them, and segmental replacement of the distal aortic arch was followed by autotransplantation because of the postoperative acute renal failure in the other one. Postoperative renal function of simultaneously operated patients was good whereas the patient who had been treated by two-staged operation needed hemodialysis for two weeks after the autotransplantation. Postoperative scintigraphy showed fully recovered function of the autotransplanted kidneys with enlargement. CT scan showed that the false lumen of the dissecting aorta was reduced in size with increased intraluminal clot formation. Renal autotransplantation with entry closure is easy and safe technique and assures successful operative results for the dissecting aneurysm, restoring impaired renal blood flow.

[Surgical treatment of incomplete endocardial cushion defect in adult patients]

Seven adult patients (> or = 40 years old) and six pediatric patients with incomplete endocardial cushion defect (ECD) underwent corrective surgery in our institution. Preoperative catheterization study showed that the left-to-right shunting rate and the pulmonary-to-systemic flow ratio were greater in adult patients than those in pediatric patients, but systolic pulmonary arterial pressure was not high and similar in the two groups. The degree of mitral regurgitation by left ventriculography was mild or moderate in both groups. However, in adult patients, a variety of arrhythmias were observed. Postoperatively, NYHA grades and arrhythmia improved markedly in the adult patients. Surgical correction for ECD is recommended even in adult patients before aggravation of cardiac failure and arrhythmia.

Effect of thyroid stimulating hormone on the development and progression of rat thyroid follicular cell tumors

Time course changes in cell proliferative activity of thyroid focal hyperplastic and tumorous lesions as well as blood thyroid-related hormones in male F344 rats initiated with N-bis(2-hydroxypropyl)nitrosamine (DHPN: 2800 mg/kg body weight, single s.c. injection) were examined following chronic administration of 0.1% sulfadimethoxine (SM) in the drinking water for 1, 4, 8, 12 and 16 weeks and at the end of a subsequent 4-week recovery period. Serum thyroid stimulating hormone (TSH) levels increased rapidly from week 1 of SM treatment, reaching a peak at week 8, and then decreased gradually with prolongation of treatment period, although remaining significantly elevated as compared with the corresponding controls at all time points up to week 16. Follicular cell hyperplasias and adenomas of the thyroid occurred from week 4 and carcinomas from week 8. All of these lesions showed high cell proliferative activities corresponding to high serum TSH levels during the early stage, but the levels in hyperplasias and adenomas decreased rapidly with prolongation of SM treatment. After the recovery period, serum TSH levels had returned to below the normal range and cell proliferation in follicular hyperplasias and adenomas had stopped or was very low. Some carcinomas demonstrating invasive growth also showed remarkable decreases in the cell proliferative activity. The results of our study strongly suggest that a high serum TSH level plays an important role in the early stage of thyroid tumorigenesis and that some tumors exhibiting invasive growth are still dependent on TSH stimulation.

Surgical palliation of cardiac malformations associated with right isomerism

Between 1985 and 1993, palliative surgery was performed on 13 pediatric patients who had complex cardiovascular anomalies associated with right isomerism. The patients included two neonates, ten infants, and one child who were divided into two groups according to whether or not a total anomalous pulmonary venous connection (TAPVC) was present. Group 1 consisted of six patients with TAPVC and group 2 consisted of seven patients without TAPVC. In group 1, the surgical procedures involved TAPVC repair alone in two patients, combined TAPVC repair with a modified Blalock-Taussig shunt in two, combined TAPVC repair with pulmonary artery banding in one, and a modified Blalock-Taussig shunt alone in one. There were five hospital deaths and one late death in this group: pulmonary venous obstruction in two patients, perioperative myocardial failure in the two neonates, and congestive heart failure caused by increased pulmonary blood flow in two patients. In group 2, all the patients underwent systemic-pulmonary artery shunts, and there was one hospital death and three late deaths, the causes of which were unknown in two patients, and shunt failure and pneumonia in one patient each. These results suggest that surgical palliation for right isomerism produces poor results in young infants with obstructed TAPVC. Thus, we conclude that TAPVC repair should be performed without delay if pulmonary venous obstruction has been diagnosed clinically. Resolving pulmonary venous obstruction without cardiopulmonary bypass (CPB) may be preferable for infants, considering their difficult management. The systemic-pulmonary artery shunt should be of the low-calibrated type, especially if common atrioventricular valve regurgitation exists. If infants survive the surgery, they must be carefully followed up for a long period due to the risk of sudden death or infection.

Comparison of hemodynamic data before and after corrective surgery for Down's syndrome and ventricular septal defect

Left ventricular function and the extent of pulmonary vascular disease were studied in 18 children with Down's syndrome and 20 children without Down's syndrome who underwent corrective surgery for ventricular septal defect (VSD) and severe pulmonary hypertension. This study was conducted between 1985 and 1993. All patients underwent routine cardiac catheterization preoperatively and postoperatively (mean, 11.4 months after surgery). Left ventricular function was estimated using cineangiographic levograms. In both groups, the pulmonary-to-systemic arterial pressure ratio (Pp/Ps) and pulmonary vascular resistance (PVR) were significantly lower after surgery (P < 0.05). Postoperative improvement was more remarkable in the non-Down group (P < 0.05). Left ventricular end-diastolic volume (percent of normal) (LVEDV%N) was significantly lower after surgery in both groups (P < 0.01). The left ventricular stroke work-to-end-diastolic volume ratio (LVSW/EDV) was significantly higher after surgery in the non-Down group only (P < 0.01). Postoperative left ventricular ejection fraction (LVEF) was significantly lower in the Down group than in the non-Down group (P < 0.01). Some degree of irreversible pulmonary vascular disease was present after repair of VSD in patients with Down's syndrome. In the Down group, there were no significant changes in left ventricular function after surgery, despite the relief of volume overload. These results suggest that early diagnosis and surgical repair are key elements in the management of patients with Down's syndrome and VSD.

Study on the carcinogenicity of tannic acid in F344 rats

The carcinogenicity of tannic acid, a compound that is used as a food additive, a clarifying agent and a refining agent, was examined in F344 rats of both sexes. Tannic acid was dissolved in distilled water at concentrations of 0.25 and 0.5%. The doses were selected on the basis of results from a 13-wk subchronic study. Groups of 50 male and 50 female rats were given one of these solutions ad lib. as their drinking water for up to 2 yr. The mean body weights of the treated males were essentially comparable with those of the controls, whereas treated females had lower mean body weights than the control group. A variety of tumours developed in all groups, including the control group, but all the neoplasms were histologically similar to those known to occur spontaneously in this strain of rats, and no statistically significant increase in the incidence of any tumour was found in the treated groups of either sex. Thus, it is concluded that, under the conditions of the experiment, tannic acid has neither carcinogenic potential in F344 rats nor modifying effects on spontaneous tumour development.

Thyroid proliferative lesions induced by anti-thyroid drugs in rats are not always accompanied by sustained increases in serum TSH

To examine changes in serum TSH and determine whether the sustained excess is necessary for the development and/or progression of thyroid tumors, male F344 rats were administered drinking water containing thiourea (TU), at 0.1 or 0.05%, or sulfadimethoxine (SM), at 0.025 or 0.0125%, for one week in Experiment I. All of the treated animals showed decreased serum levels of T3 and T4 and an increased TSH. In Experiment II, male rats were given a s.c. injection of N-bis(2-hydroxypropyl) nitrosamine (DHPN:1500 mg/kg BW) and, starting one week later, received drinking water containing the same doses of TU or SM as in Experiment I for the following 20 weeks. Thyroid follicular proliferative lesions were induced in most rats treated with TU and SM. However, these treated animals did not demonstrate any consistent alterations in serum T3, T4 and TSH levels, except for the high dose TU group. The present studies thus suggest that thyroid tumors can grow even under conditions of fluctuating serum TSH levels during the progression phase, although TSH stimulation might be an absolute requirement in the early phase of tumor development.

[Renal tubular dysfunction in open pediatric heart surgery--preventive effect of haptoglobin]

Preventive effect of haptoglobin (Hb) for renal tubular dysfunction was studied in 16 pediatric patients undergoing open heart surgery under extracorporeal circulation (ECC). The patients were divided into two groups; Hp(+) group consisting of 7 patients administered haptoglobin (100 U/kg) in priming of ECC, and Hp(-) group of 9 patients not administered haptoglobin. As parameters of renal tubular function, urinary alpha 1-microglobulin-index (U-alpha 1m.I), urinary beta 2-microglobulin-index (U-beta 2m.I), urinary N-acetyl-beta-D-glucosaminidase-index (U-NAG.I), fractional clearance of alpha 1m (Fc-alpha 1m) and beta 2m (Fc-beta 2m), as well as Free-Hb, were measured just before start of ECC and then at periodical time after ECC to the 7th day. The results obtained are as follows. (1) Maximum Free-Hb in Hp(+) group was significantly less (p < 0.05) than that in Hp(-) group. (2) Every parameter of renal tubular function were shown a peak at the end of ECC. Maximum values of U-alpha 1m.I, U-NAG.I and Fc-alpha 1m in Hp(+) group were significantly less (p < 0.05) than those in Hp(-) group. Maximum U-beta 2m.I and Fc-beta 2m in Hp(+) group were less than those in Hp(-) group, although there was no significant difference. These results indicate that administration of haptoglobin suppresses the increase of Free-Hb and is useful for prevention of renal tubular dysfunction during ECC.

Synergistic effects of phenobarbital and thiourea on proliferative lesions in the rat liver

To evaluate the effects of phenobarbital (PB) and thiourea (TU), alone or in combination, on proliferative lesions of the liver, thyroid and lung, male F344 rats initiated with 2000 mg/kg body weight N-bis(2-hydroxypropyl) nitrosamine (DHPN) were given diet and/or drinking water containing 0% PB/TU (group 1), 1000 ppm PB (group 2), 0.1% TU (group 3) and 500 ppm PB and 0.05% TU (group 4), from weeks 2 to 20 for 19 weeks. Group 4 showed remarkable increases in the number of hepatocellular altered foci per animal, the values being superior to the averages of groups 2 and 3. The number of thyroid proliferative lesions per animal was highest in group 3 and lowest in group 2. Lung proliferative lesions were induced in all groups, but no modifying influence on their development was evident in the combined group. The present results indicate that combined administration of PB and TU exerts synergistic enhancing effects on hepatocarcinogenesis.

Spontaneous renal cell tumors in Long-Evans Cinnamon rats

Neoplastic lesions of the kidneys in untreated Long-Evans Cinnamon (LEC) rats of 57-118 weeks old (85 males and 34 females) and male F344 rats of 64-93 weeks old (59 males) were examined histologically. The incidences of renal cell tumors in male and female LEC rats were 6/80 (8%) in weeks 57-65, 3/19 (16%) in weeks 66-75, 3/8 (38%) in weeks 76-105 and 7/12 (58%) in weeks 106-118. Of these tumors, 13 were microscopic adenomas and 7 were renal cell carcinomas. The copper content of the kidneys was about three times higher in LEC rats than in F344 rats (P < 0.001), but the iron content of the kidneys was similar in the two strains.

[Concentrations of new quinolone agents in serum and prostate tissue]

Twenty five patients with benign prostate hypertrophy were administered ofloxacin (OFLX) simultaneously with norfloxacin (NFLX) in 6 patients, ciprofloxacin (CPFX) in 10, tosfloxacin (TFLX) in 5 and enoxacin (ENX) in 4 patients. The dose of these new quinolones was 100 mg (except 150 mg of TFLX). Their concentrations in the serum and the prostate tissue were measured by high performance liquid chromatography (HPLC). The serum concentration of OFLX was significantly higher than that of NFLX, CPFX, TFLX or ENX. The prostate tissue concentration of OFLX was significantly higher than that of CPFX or TFLX. The ratio of tissue versus serum concentration of each new quinolone agent was not significantly different. The high OFLX tissue concentration appeared to be caused by the high serum concentration.

[The significance of six sextant biopsy for prostate cancer]

The significance of six sextant ultrasound guided biopsies of the prostate (SS-biopsy) was evaluated in a total of 114 patients. The presence of prostate cancer was suspected (Pca) in 59 subjects through mass screening (MS) for Pca and in 47 patients in out-patient clinics (OPC). The recurrence (REC) was suspected in 3 patients diagnosed previously as Pca. All of them had elevated PSA, abnormal digital rectal examination (DRE) and/or abnormal transrectal ultrasonography (TRUS). All of these tests in 5 patients with benign prostate hypertrophy (BPH) were normal. Moreover, in 34 patients among them, oriented biopsies were performed to the area where Pca was suspected by DRE and or TRUS. Twelve Pca patients were detected in MS group (20.3%), 17 Pcas in OPC group (36.2%) and 3 Pcas in REC group (100%). No Pca patients were detected in BPH group. In 12 Pca patients with T1 or T2, only one Pca patient (8.3%) had over 3 Pca samples among the samples obtained by SS-biopsy. In 20 patients with T3 or T4, 13 patients (65%) had over 3 Pca samples. There was significant relationship between T category and Pca sample numbers among 6 samples obtained by SS-biopsy (p < 0.01). Ten of 12 Pca patients in MS group (83.3%) and 8 of 17 patients in OPC group (47.1%) had less 3 Pca samples. Pca was detected in 9 of 34 patients examined by the oriented biopsy. However al of these Pca were detected by SS-biopsy. It may be not necessary to examine Pca suspected patients by the oriented biopsy if they were examined by this SS-biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of mitral valve re-replacement with radical correction of Bland-White-Garland syndrome]

A case of an 8-year-old girl with Bland-White-Garland syndrome (BWG) who successfully underwent a second mitral valve replacement is reported. The patient had a past history of mitral valve replacement under the diagnosis of mitral regurgitation and pulmonary hypertension at one year and 3 months of age. Cardiac catheterization at 6 years and 3 months of age revealed an anomalous origin of the left coronary artery from the pulmonary artery but she was asymptomatic. One year and 7 months later, she was admitted to our institution with a sudden onset of chest pain and respiratory distress. Right heart pressure study using a Swan-Ganz catheter showed severe pulmonary hypertension and elevated mean pulmonary wedge pressure (38 mmHg). Echocardiogram revealed severe mitral stenosis and moderate regurgitation. She was diagnosed under fluoroscopy as acute left cardiac failure due to stuck valve and suspected having myocardial damage due to BWG, thus, emergency surgery was performed. Under cardiopulmonary bypass, aorto-left coronary arterial continuity was established by intrapulmonary arterial tunnel using Hamilton's technique. After resection of the prosthetic valve, of which one of two leaflets had been fixed in pannus, re-MVR was done with a St. Jude. Medical valve (25 mm). Postoperative angiogram demonstrated satisfactorily reconstructed two coronary artery systems. Postoperatively, she has been doing well without complaint for the last eighteen months.

[A case of papillary fibroelastoma of the heart found 13 years after open mitral commissurotomy]

A patient, 68-year-old female, underwent open mitral commissurotomy (OMC) for rheumatic mitral stenosis in April, 1979. In July of 1992, during the postoperative follow-up echocardiogram showed 8 x 7 mm mitral subvalvular tumor mass and mitral restenosis. Then, mitral valve replacement was performed using prosthetic valve (Carbomedics #25 mm). The tumor was located on the top of postero-medial papillary muscle and its chordae, and histologically was diagnosed as benign papillary fibroelastoma. Based on the findings of periodic echocardiogram, the tumor doubling time was estimated to be 283 days. The postoperative course was uncomplicated and she was discharged on the 34th post operative day. Papillary fibroelastoma is a rare benign cardiac tumor. Pathological origin of this tumor is still unknown. However, Lambl's excrescence, long-term inflammatory stimulation and/or thrombi are supposed to be etiologic factors. This tumor is generally found incidentally at the time of autopsy or operation because the patients are often asymptomatic. However, because the tumor causes embolism at times, periodic examination by echocardiogram after operation preserving valves is recommended, and surgical resection is required when the diagnosis is established.

A study on gamma-aminobutyric acid (GABA) and its analogues by using molecular orbital methods: on epileptogenicity of new quinolones

Using the molecular orbital methods, we examined molecular structure, electron density distribution, electrostatic potential field and receptor structure of gamma-aminobutyric acid (GABA), and its analogues. The following findings were obtained: a comparison of the biological activity and the morphology electrostatic potentials of GABA analogues disclosed that the active site is the amino group, and the biological activity correlates closely with the electrostatic potential structure around the amino group. The active sites were compared between the receptor-binding molecules and the GABA uptake inhibitory molecules, and the results suggested that the receptor structure differed between the two groups of molecules and that the GABA A receptors had two subtypes. On these results, the epileptogenicity of new quinolones was studied using this method. These results suggested that the new quinolones blockaded the GABA receptor-binding system and that the important active site of the new quinolones for GABA receptor-binding was the the piperazyl amino group. These results suggested that the concentration of zwitterion type of the new quinolones was very important clinically.

[Symptoms and signs of benign prostate hypertrophy (BPH)]

Clinical characteristics of BPH were investigated in the relationship among prostate volume estimated by transrectal sonography, symptoms by questionnaire, residual urine volume, and voiding force evaluated by uroflowmetry. There was no apparent relationship among them, which might be caused by the poor reproducibility of residual urine volume, the difficult enumeration of the symptoms, contamination of other diseases of which voiding disorder is correlated with aging and other unknown factors. Under such a situation, this disease should be treated as a BPH syndrome. Moreover we propose that BPH syndrome should be classified into three types; type 1: symptomatic BPH without enlarged prostate, type 2: asymptomatic BPH with enlarged prostate and type 3: symptomatic BPH with enlarged prostate.

Bilateral renal angiomyolipoma associated with bilateral renal vein and inferior vena caval thrombi

We report a case of bilateral renal angiomyolipoma with thrombosis of the bilateral renal veins and inferior vena cava. Right partial nephrectomy and total thrombectomy were performed. To our knowledge only 5 cases of invasion of the inferior vena cava have been described. We report a case in which the renal veins were involved bilaterally. Treatment modalities are discussed.

[A ruptured thoracic aortic aneurysm with 4 cm diameter]

The size of a thoracic aortic aneurysm (TAA) is an important factor of the operative indication. We experienced a ruptured TAA the diameter of which was only 4 cm. A 71 years old man was admitted due to the severe back pain under the shocked condition. We diagnosed him a ruptured TAA by CT scan. Because he had no progressive anemia and the hemodynamics was very stable, we followed him conservatively. Two months later, the operation was performed. We resected the aneurysm and inserted an aortic prosthetic graft. From the operative findings, the aneurysm was certified as a true aneurysm, and the maximal diameter was only 4 cm. First choice for the treatment of ruptured TAA is the emergent operation. But when the hemodynamics is extremely stable and the anemia does not progress at all, a conservative therapy can be selected. Even if the aneurysm is very small, the control of hypertension is quite important.

[Subchronic oral toxicity study of cyanoguanidine in F344 rats]

A 13-week subchronic oral toxicity study of cyanoguanidine was performed in male and female F344 rats by feeding of CRF1 powder diets containing 0, 1.25, 2.5, 5 and 10% cyanoguanidine to determine appropriate dose levels for a subsequent 2-year carcinogenicity study. The rats were randomly allocated to 5 groups, each consisting of 10 males and 10 females. No animals died during the administration period. Inhibition of body weight gain was more marked in both sexes of the 10% group and in females of the 5% group as compared with the control group. Mean food intake in males of the groups treated with 5% or 10% and in females of the 10% group was significantly higher than that in the control group. Serum biochemical investigation revealed a higher level of serum BUN in both sexes of the 10% group. On histopathological examination, toxic changes characterized by the occurrence of intranuclear eosinophilic inclusion bodies in the proximal tubular epithelium of the kidney were observed in both sexes of the 10% group. Similar inclusion bodies were also seen in 2 out of 10 males of the 5% group. From these results, it was concluded that a level of 10% of cyanoguanidine in the diet is unequivocally toxic. A dose level, 5% cyanoguanidine, in the diet might be appropriate as a high dose for a carcinogenicity study.

[Prognostic factor for prostate cancer. Gunma Urological Oncology Study Group]

The study of prognostic factors in patients with prostate cancer (Pca) may be of value in understanding the natural history of the disease and may also assist in planning and analyzing the results of clinical trials. Moreover some information through this study would be beneficial to assessing the prognosis and decision of better therapy form of individual patients. The significance of items studied was evaluated from the two view points, survival rate and Pca death rate. Stage, pathological differentiation and acid phosphatase were significantly related to them, in the category grade depending manner. Past history and complication, and age were also significantly related to them but higher category grade as a survival factor showed lower Pca death rates. ESR, gait disturbance and hematuria were related to only survival rate. Any significant relationship was not observed in serum testosterone, voiding disturbance and cancer-pain. Prognostic factors should be clinically used through the well understanding of each characteristics. This paper also showed that statistical significance not always provide a wide difference between categories compared.

[Combination therapy of renal cell carcinoma with interferon-alpha and UFT (or FT-207)]

Human lymphoblastoid interferon (IFN-alpha MOR-22; OIF) was administered to forty-two patients suffering from renal cell carcinoma. Twenty-six patients with metastatic lesions or primary tumor were treated in a clinical trial with either MOR-22 alone or combination of MOR-22 and UFT (or FT-207). The efficacy was assessed in ten of twenty patients who had received MOR-22 alone for more than eight weeks, but objective response was not observed. The efficacy was done in eight of fourteen patients with MOR-22 and UFT (or FT-207) in combination. Complete response was achieved in one, and partial response in two, with an objective response rate of 37.5%. But the difference was no statistically significant in the survival rate of each therapy. In evaluable twenty patients with MOR-22 prophylactically, there was only one case who had occurred lung metastases with a refractory rate of 8.3%. Forty-one patients were examined for side effects to drugs. The main side effects were fever, anorexia, general fatigue, hematologic toxicities, and hepatic dysfunction in both therapy. These side effects occurred with more increased frequency in combination therapy of UFT (or FT-207) compared to MOR-22 alone.

[Postoperative thromboembolism of acquired mitral valve disease--comparison between valve replacement and commissurotomy]

Thromboembolism after mitral commissurotomy (MC) was compared with that after mitral valve replacement (MVR). In 216 surgical cases of acquired mitral valve diseases, including combined operative cases of other valves, thromboembolic complications after MC were observed in 9/137 cases (13 times, 0.94%/patient-year), and those after MVR in 8/70 cases (11 times, 2.55%/patient-year). No thromboembolism occurred in 9 cases of annuloplasty. Thromboembolism-free period after MVR (49 +/- 44 months) was significantly shorter than that after MC (102 +/- 43 months, p less than 0.05). Postoperative CTR of thromboembolic cases (69.5 +/- 8.2%) was significantly larger than that of non-thromboembolic cases (61.4 +/- 9.9%) in MVR group (p less than 0.005), but no significant difference existed between thromboembolic and non-thromboembolic cases in MC group. Thromboembolism after MVR occurred in severe cases, but that after MC often occurred in mild cases. Postoperative echocardiogram of MC group showed significantly lower DDR in thromboembolic cases (1.9 +/- 0.7 cm/sec) than in non-thromboembolic cases (3.2 +/- 1.2 cm/sec, p less than 0.025). Mitral valve area (MVA) of all re-stenotic cases in thromboembolic cases after MC was under 1.5 cm2, comparing that in non-thromboembolic cases there were only two cases that had MVA under 1.5 cm2. After MC, careful management including anticoagulant therapy and reoperation is necessary especially in patients with atrial fibrillation, DDR under 2 cm/sec, and MVA under 1.5 cm2, even though they don't have cardiomegaly.

A pulsatile pump for cardiopulmonary bypass and its clinical use

A pulsatile pump driven by a coil spring, which was designed and constructed by us, is described in this report. It consists of two main parts, a disposable blood chamber and a driving section. The blood chamber has two leaflet valves and a piston, which is covered with two bellofram rolling diaphragms and moves into the housing to draw in and eject the blood. The driving section consists of three cams, an electric motor and a coil spring. The ejection force is wholly produced by the compressed coil spring and is transmitted to the piston in the blood chamber by a rod. This pump allows the ejection pressure, the beat rates, and the stroke volume all to be changed independently. The performance of the pump was tested by using a circulation model where the beat rate was adjusted from 30 to 250 bpm. The output subsequently increased from 0.8 l/min to 5.7 l/min and the stroke volume, from 20.4 ml to 36.7 ml. This new pump has been used for clinical cardiopulmonary bypasses in 24 patients of open heart surgery and the pressure traces during perfusion resembled those of the patients' own hearts.

[Changes in Ca++-ATPase activity of rat myocyte under cardioplegia]

Ischemic changes of cardiac muscle under cardioplegia must be evaluated at a subcellular level from functional aspects using cytochemical procedures as well as from morphological aspects. In this study, kinetics of Ca++-ATPase activity of rat cardiac myocytes under GIK-cardioplegia was estimated using a new one-step lead citrate method reported by Ando et al. The Ca++-ATPase activity of mitochondria in myocytes which had temporally increased at 15 minutes after initiation of cardioplegia, showed a slight decrease at 30 minutes and then almost disappeared at 60 minutes. At 60 minutes after the cardioplegia, the Ca++-ATPase activities of the sarcoplasmic reticula and myofilaments were well preserved and electromicroscopic findings of the myocytes remained normal. Thus, changes of Ca++-ATPase activity of mitochondria are considered to reflect ischemic damage of myocyte sharply, proceeding morphological changes in ultrastructure.