(S)-(-)-blebbistatin O-benzoate has the potential to improve atopic dermatitis symptoms in NC/Nga mice by upregulating epidermal barrier function and inhibiting type 2 alarmin cytokine induction

Atopic dermatitis is a multi-pathogenic disease characterized by chronic skin inflammation and barrier dysfunction. Therefore, improving the skin's ability to form an epidermal barrier and suppressing the production of cytokines that induce type 2 inflammatory responses are important for controlling atopic dermatitis symptoms. (-)-Blebbistatin, a non-muscle myosin II inhibitor, has been suggested to improve pulmonary endothelial barrier function and control inflammation by suppressing immune cell migration; however, its efficacy in atopic dermatitis is unknown. In this study, we investigated whether (S)-(-)-blebbistatin O-benzoate, a derivative of (-)-blebbistatin, improves dermatitis symptoms in a mite antigen-induced atopic dermatitis model using NC/Nga mice. The efficacy of the compound was confirmed using dermatitis scores, ear thickness measurements, serum IgE levels, histological analysis of lesions, and filaggrin expression analysis, which is important for barrier function. (S)-(-)-Blebbistatin O-benzoate treatment significantly reduced the dermatitis score and serum IgE levels compared to those in the vehicle group (p < 0.05). Furthermore, the histological analysis revealed enhanced filaggrin production and a decreased number of mast cells (p < 0.05), indicating that (S)-(-)-blebbistatin O-benzoate improved atopic dermatitis symptoms in a pathological model. In vitro analysis using cultured keratinocytes revealed increased expression of filaggrin, loricrin, involucrin, and ceramide production pathway-related genes, suggesting that (S)-(-)-blebbistatin O-benzoate promotes epidermal barrier formation. Furthermore, the effect of (S)-(-)-blebbistatin O-benzoate on type 2 alarmin cytokines, which are secreted from epidermal cells upon scratching or allergen stimulation and are involved in the pathogenesis of atopic dermatitis, was evaluated using antigens derived from mite feces. The results showed that (S)-(-)-blebbistatin O-benzoate inhibited the upregulation of these cytokines. Based on the above, (S)-(-)-blebbistatin O-benzoate has the potential to be developed as an atopic dermatitis treatment option that controls dermatitis symptoms by suppressing inflammation and improving barrier function by acting on multiple aspects of the pathogenesis of atopic dermatitis.

The Lipid-Binding Defective Dynamin 2 Mutant in Charcot-Marie-Tooth Disease Impairs Proper Actin Bundling and Actin Organization in Glomerular Podocytes

Dynamin is an endocytic protein that functions in vesicle formation by scission of invaginated membranes. Dynamin maintains the structure of foot processes in glomerular podocytes by directly and indirectly interacting with actin filaments. However, molecular mechanisms underlying dynamin-mediated actin regulation are largely unknown. Here, biochemical and cell biological experiments were conducted to uncover how dynamin modulates interactions between membranes and actin in human podocytes. Actin-bundling, membrane tubulating, and GTPase activities of dynamin were examined in vitro using recombinant dynamin 2-wild-type (WT) or dynamin 2-K562E, which is a mutant found in Charcot-Marie-Tooth patients. Dynamin 2-WT and dynamin 2-K562E led to the formation of prominent actin bundles with constant diameters. Whereas liposomes incubated with dynamin 2-WT resulted in tubule formation, dynamin 2-K562E reduced tubulation. Actin filaments and liposomes stimulated dynamin 2-WT GTPase activity by 6- and 20-fold, respectively. Actin-filaments, but not liposomes, stimulated dynamin 2-K562E GTPase activity by 4-fold. Self-assembly-dependent GTPase activity of dynamin 2-K562E was reduced to one-third compared to that of dynamin 2-WT. Incubation of liposomes and actin with dynamin 2-WT led to the formation of thick actin bundles, which often bound to liposomes. The interaction between lipid membranes and actin bundles by dynamin 2-K562E was lower than that by dynamin 2-WT. Dynamin 2-WT partially colocalized with stress fibers and actin bundles based on double immunofluorescence of human podocytes. Dynamin 2-K562E expression resulted in decreased stress fiber density and the formation of aberrant actin clusters. Dynamin 2-K562E colocalized with α-actinin-4 in aberrant actin clusters. Reformation of stress fibers after cytochalasin D-induced actin depolymerization and washout was less effective in dynamin 2-K562E-expressing cells than that in dynamin 2-WT. Bis-T-23, a dynamin self-assembly enhancer, was unable to rescue the decreased focal adhesion numbers and reduced stress fiber density induced by dynamin 2-K562E expression. These results suggest that the low affinity of the K562E mutant for lipid membranes, and atypical self-assembling properties, lead to actin disorganization in HPCs. Moreover, lipid-binding and self-assembly of dynamin 2 along actin filaments are required for podocyte morphology and functions. Finally, dynamin 2-mediated interactions between actin and membranes are critical for actin bundle formation in HPCs.

[Mitral valve plasty for infective endocarditis associated with vertebral osteomyelitis]

Infective endocarditis (IE) associated with vertebral osteomyelitis (VO) is relatively rare, but needs long and careful therapy. We report a case of the patient who was incidentally diagnosed as having IE during therapy for VO. A 77-year-old man was hospitalized with a complaint of high fever and back pain. Because magnetic resonance imaging demonstrated osteomyelitis, antibiotic therapy was started. Persistent infectious signs and congestive heart failure indicated the diagnosis of infective endocarditis. Echocardiogram demonstrated sever mitral regurgitation due to perforation of anterior mitral leaflet but no vegetation. Surgery revealed perforation of the valvular aneurysm of the anterior mitral leaflet, which was successfully repaired with deberidement and patch closure. Antibiotic therapy was continued for 4 months postoperatively. In the case of VO, it is often necessary to consider an association of IE, although it is hardly possible to determine which the preceding infection is.

Primary embryonal carcinoma of heart with SVC syndrome

We present a case report of a 25-year-old man with embryonal carcinoma of right atrium and multiple lung metastases featuring SVC syndrome. We resected the cardiac tumor which occupied the right atrium and performed left upper lobectomy. No tumor mass or vestige was detected in the testes. Cis-platinum based combination chemotherapy was performed for residual lung tumors, which leads to the complete remission.

Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery

A saccular aneurysm in the right-sided aortic arch with aberrant left subclavian artery is an uncommon disease, and surgical treatment is complicated. Three patients with Edwards type III-B right aortic arch and enlargement of the Kommerell's diverticulum underwent operations. Right thoracotomy was the preferred approach for this lesion and partial cardiopulmonary bypass is a safe and simple procedure when the aortic arch has mild atherosclerosis.

Impending rupture in an aortic arch aneurysm by Candida infection

A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection.

Primary osteosarcoma of heart with severe congestive heart failure

We present a case report on a 54-year-old woman with extraskeletal osteosarcoma of the left atrium featuring severe congestive heart failure. We resected the tumor, which occupied the left atrium and had widely infiltrated the atrial wall, but the patients died of the tumor 9 months after surgery. This is to our knowledge the 32nd case of cardiac osteosarcoma ever reported.

[Combined CABG and valve operation]

We presented 20 patients, who were underwent combined valve and coronary artery bypass surgery in our institute from September 1995 to December 1999. They were 13 male and 7 female, ages ranged from 54 to 79 (mean 67.5 years). Previous cardiac operation was done in 2 cases. The patients carried out a combination of CABG with aortic valve replacement (n = 9), mitral valve replacement (n = 4), mitral valve plasty (n = 6), double valve replacement (n = 1). Emergency operation was performed in 2 cases. The hospital mortality was 5%. One patient who was underwent mitral valve repair and CABG died due to severe heart failure 2 week post operatively. The perioperative complications were found in 2 patients, one was acute renal failure with HD, the other was cerebral infarction. There are no patient with perioperative myocardial infarction. The combined operation of valvular surgery and CABG for the patients with coexisting disease might be safety and reliable methods, even in older one.

[Predonation and transfusion in open heart surgery]

The efficacy of predonation of autologous blood in reducing the use homologous blood during open heart surgery was investigated. Between January 1997, and February 1998, predonation and transfusion was studied in 100 consecutive open heart operations (CABG, 77; valve surgery, 17; ASD, 5; myxoma, 1). The guidelines for autologous predonation were as follows: an age < 70 years, a weight > 40 kg and a hemoglobin > 12 g/dl. Patients in NYHA class IV or undergoing emergency operation were excluded. The blood loss during operation ranged from 195 to 1,850 ml (mean; 670 ml), being from 305 to 1,850 ml (723 ml) for CABG, from 260 to 1,020 ml (493.5 ml) for valve surgery and from 195 to 570 ml (342 ml) for ASD. The blood loss was not significantly dependent on sex or age and did not differ elective and emergent operations. Only 36.6% of patients with autologous predonation needed homologous transfusion versus 63.4% of those without predonation. Homologous transfusion was done in only 5% of the those with predonation of 800 ml versus 69% at 400 ml and 71% at 200 ml. In conclusion, autologous blood transfusion is effective for reducing the homologous blood requirement. It also seems that predonation of 800 ml may be sufficient to allow open heart surgery without blood transfusion.

[Uretero-external iliac artery fistula: a case report]

We report a case of uretero-external iliac artery fistula. A 60-year-old female was referred to our hospital complaining of intermittent gross macrohematuria. She had undergone radical hysterectomy, radiation therapy and chemotherapy for advanced cervical cancer 2 years ago. The patient had a 7 Fr ureteral double-J stent for left hydronephrosis. Retrograde urography showed a filling defect (8 mm in diameter) of the left ureter. A contrast-enhanced computed tomographic scan showed left hydronephrosis and hydroureter but no evidence of fistula formation or extravasation. A pelvic arteriography revealed a pseudoaneurysm of the left external iliac artery at the crosspoint between the left ureter and the iliac artery. Surgical repair of the left uretero-external arterial fistula was successfully performed as well as left nephroureterectomy. The possibility of fistula formation between ureter and artery should be kept in mind in patients with long-term indwelling ureteral stents and history of radiation therapy.

Evidence of apoptosis induced by myocardial ischemia: A case of ventricular septal rupture following acute myocardial infarction

Recent studies have reported that apoptosis may be induced by reperfusion injury following ischemia in cardiomyocytes. We present a case with evidence of apoptosis induced by myocardial ischemia without reperfusion. DNA fragmentation was demonstrated in the nuclei of the myocardial cells surrounding the ventricular septal rupture following acute myocardial infarction without reperfusion in the infarct-related left anterior descending coronary artery. This finding suggests that ischemia without reperfusion may induce apoptosis in myocardial cells.

Mitral valve replacement in a patient with an extensively calcified mitral anulus: report of a case

We report herein the case of a patient with chronic renal failure in whom mitral valve stenosis with extensive mitral anular calcification involving the entire anulus and leaflets was successfully treated surgically. Excision of both leaflets and partial resection of the anular calcification enabled the insertion of a 23-mm St. Jude Medical prosthetic valve. The technical difficulties involved with inserting the appropriate-sized prosthetic valve in a narrowed mitral anulus with heavy calcification are discussed following this case report.

[CarboMedics "Top Hat" supraannular prosthesis in the small aortic root with severe calcification: a case report]

A 71-year-old man with aortic stenosis due to calcification successfully underwent aortic valve replacement with a 21-mm CarboMedics "Top Hat" supraannular prosthesis. We were able to implant a "Top Hat" valve one size larger than would have been possible using a standard bileaflet valve. The postoperative recovery was uneventful, and echocardiography showed a peak gradient of 23 mmHg for this prosthesis. The CarboMedics supraannular valve allowed a gain in size over standard prostheses, resulting in favorable hemodynamics. This valve may be useful in difficult or unsuitable cases to enlarge the narrow aortic valve ring, such as patients with severe calcification of aortic root, elderly patients with less activity, or patients who can tolerate only short cardiopulmonary bypass time due to cardiac dysfunction.

[Cardiac operation for aged patients (aged 75 years and over): results of surgical intervention]

We evaluate the results of cardiac operation for 41 elderly patients (aged 75 years and over, mean, 77.5 years old). The overall hospital mortality was 12.2% (5/41) with mortality of 8.3% (2/24) in cases of elective operation and mortality of 17.6% (3/17) in cases of emergency operation. Causes of hospital death in emergency cases were congestive heart failure and left ventricular rupture (two cases) due to acute myocardial infarction. Patients who died in elective operation had been performed reoperation for bleeding and unstable sternum. These complications which need a reoperation seemed to be a potential risk for elderly patients. Because of poorer results of the emergency case, it is advocate to operate on these aged patients with an elective basis, if there is no absolute contraindications.

[A case report of an infective endocarditis caused by methicillin-resistant Staphylococcus aureus with successful mitral valve replacement]

We report a case of successful mitral valve replacement performed on the patient who is an infective endocarditis due to MRSA. She was 27-year-old female and treated by antibiotics medication because of remittent fever two years ago. On August 1995, cerebral infarction occurred and she was pointed out endocarditis. After high fever continued, blood cultures demonstrated MRSA. Furthermore, echocardiography showed vegetation on posterior mitral valve leaflet and moderate mitral regurgitation so, mitral valve replacement with a S.J.M. 25 mm performed to control MRSA sepsis condition. During operation, we used VCM 2 g into the extracorporeal circulation and after operation 0.5 g intravenously every 6 hours. Two weeks later we changed antibiotics to FOM, Viccillin and ABK according to the result of minimum inhibitory concentration (MIC) obtained through blood culture. The patient was discharged on the 44 th postoperative day because of her uneventful postoperative course.

[Rupture of the aneurysm of the sinus valsalva: thirteen years after the initial diagnosis]

We report a case of an unruptured aneurysm of the sinus Valsalva (URASV) which was followed thirteen years without surgery. A 47-year-old female had a heart murmur detected at age 34 during pregnancy. Though an URASV was diagnosed, because the aneurysm was less than 1 cm in size, no surgery was advised at that time. Thirteen years later, she gradually noticed of increased heart beats and also dyspnea on exertion. Echocardiogram showed an aneurysm of the sinus Valsalva ruptured to the RV cavity. In June 1994, resection of the aneurysm was performed. One year later, the patient was asymptomatic. This may be the second longest long-term follow-up report of the patient with an unruptured aneurysm of the sinus Valsalva.

[A case of mitral valvuloplasty with concomitant CABG in an aged patient]

A 79-year-old man was referred to our hospital complaining of the manifestation of mild heart failure. Echo cardiography and LV gram showed sever mitral regurgitation by the prolapse of posterior leaflet. CAG revealed coronary artery disease affected two vessels (LAD and RCA) without symptoms. Quadrangular resection of posterior leaflet (McGoon's method) without annuloplasty and concomitant single CABG to the LAD using a saphenous vein were performed. Postoperative course was satisfactory and the manifestation of heart failure was diminished. Mitral valvuloplasty with concomitant CABG may be a safe and effective procedure in the treatment of aged patients.

[Simultaneous operations for both the repair of the aortic arch aneurysm and repeated CABG]

A 73-year-old female complaining of left thoracic pain was referred to our hospital. In 1988, she had the first CABG of the left circumflex coronary artery (CX) and right coronary artery. On admission in April 1994, chest X-ray and CT scan revealed a saccular aortic aneurysm, 5 x 5 cm in size, extending to the distal to the left subclavian artery. Coronary arteriography showed a patency of the CX graft, but 99% stenosis of the proximal left anterior descending branch (LAD) with delayed opacification. After the repeated median sternotomy, cardiac arrest was achieved with the aortic cross clamping and St. Thomas Hospital solution infusion. CABG to the LAD branch using a saphenous vein was accomplished. Following this, the replacement of the aortic aneurysmal lesion with a prosthetic graft was performed under the selective cerebral perfusion with deep hypothermia. Proximal anastomosis of the vein graft was completed during a rewarming period. The operation was performed without complications. Postoperative course was satisfactory except a few minor transient complications such as athelectasis of the left upper lobe and the intra-thoracic hematoma. After one month's hospitalization, she was discharged, and currently (six months postoperative) remains asymptomatic.

[A case of left atrial ball thrombus]

A 76-year-old man admitted to one hospital complaining of transient left hemiparesis. Because of arrhythmia, he was examined by an echocardiogram and found to have an oval free-floating thrombus in his left atrium concomitant with mitral stenosis. He was transferred to our hospital for emergency surgery. On operation, a 3 x 4 cm ball thrombus was removed and diseased mitral valve was replaced with a SJM prosthetic valve. His postoperative course was relatively uneventful. Though left atrial ball thrombus is rarely found among the patients with mitral valve disease, when left atrial ball thrombus is found, immediate surgical intervention is recommended to avoid sudden death.

[A successful VA bypass treatment in patient with severe pulmonary hypertension]

Report of a case of a patient with pulmonary hypertension associated with pericardial effusion who was treated by VA bypass during life-threatening right ventricular failure. A 63-year-old man was admitted to our hospital complaining of chest pain and dyspnea. Echocardiography revealed the patient had severe pulmonary hypertension and pericardial effusion. Though there were deep Q waves in ECG, his coronary angiography revealed normal coronary arteries. Pulmonary scintigraphy showed no evidence of pulmonary thromboembolism. As he developed hypotension and anuria, emergency pericardial drainage was carried out without any beneficial effect. Because no effective drugs were found to control his systemic hypotension and pulmonary hypertension, he was treated by VA bypass to save his life. Although his systemic pressure rose to normal level following institution of VA bypass, his pulmonary pressure remained high constantly, around 60-70mmHg. The VA bypass was discontinued on the 6th day because of bleeding tendency. 3 months after VA bypass, though he had not been given any drugs to control pulmonary hypertension, his pulmonary arterial pressure dropped down to within normal range. Though the exact mechanism or etiology of pulmonary hypertension remained unclear, this may be a rare case treated by VA bypass successfully for life-threatening right ventricular failure caused by pulmonary hypertension.

[A successful case of tricuspid valvulectomy for Ebstein's anomaly with severe tricuspid stenosis]

A 44-year-old male was admitted to our hospital complaining of general fatigue and dyspnea on exertion with congestive heart failure (NYHA IV). Cardiac catheterization and angiogram revealed Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Because of tiny right ventricular chamber, the usual surgical treatment for Ebstein's anomaly i.e. tricuspid valve replacement or valvuloplasty were deemed to be inappropriate. Tricuspid valvulectomy was performed to relieve the inflow stenosis of the right ventricle and excellent symptomatic relief was achieved. It is very rare to seen an adult case of Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Tricuspid valvulectomy may be justified to use in this rare condition.