Anatomical evaluation of facial nerve pathways and dissection of "premasseter space" for rhytidectomy in Asians

BACKGROUND

Partial detachment of the superficial musculoaponeurotic system (SMAS) by dissection of the premasseter space (PMS) is an option for enhancing the effectiveness of SMAS-based rhytidectomy. The aim of this study was to identify the underlying cause of the potential risk of motor nerve impairment sometimes caused by PMS dissection and to consider the effective use of PMS dissection, especially in Asians.

METHODS

Detailed dissection was carried out on six fixed Japanese cadavers to evaluate facial nerve pathways around the PMS.

RESULTS

The anterior wall of the PMS was opaque because each face exhibited fibers of various thicknesses within and around the anterior border of the masseter. The ascending ramifications of the buccal trunk ran through the fibers, outside the anterior border of the masseter in some faces but within it in others.

CONCLUSIONS

This study revealed the presence of a danger zone when dissecting the PMS in Asians. Severing the fibers that fix the SMAS to the masseter fascia around the anterior border of the masseter is sometimes unavoidable to attain good mobility of the SMAS. Surgeons must be mindful of the fibers near the anterior border of the masseter because they may be outside the PMS and contain buccal trunk ramifications; the anterior wall of the PMS tends to be opaque in Asians. Nonetheless, the extent of PMS dissection should be determined on an individual basis. The present findings may help to reduce relevant risks in Asian patients and standardize procedures for effective rhytidectomy.

LEVEL OF EVIDENCE IV

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Development of a device to determine the stiffness of elastic garments and bandages

Objective

To evaluate the reliability of a newly developed stiffness-determining device, composed of a leg mannequin and air-pack type analyser, for measuring the interface pressure.

Method

The correlation of stiffness values obtained employing the Hohenstein method and this new method was investigated using 17 different brands of medical elastic compression stocking.

Results

A significant correlation in stiffness values using the two methods was obtained ( P < 0.01). When this new method was applied to the bandages, the stiffness was significantly correlated with the initial pressure when assessing both short-stretch and long-stretch bandages. On the comparison of stiffness values between elastic stockings and bandages with the same initial pressure, the short-stretch bandages showed a predominantly higher value than long-stretch bandages and stockings ( P < 0.01).

Conclusion

The reliability of this new method, which can be easily applied to not only elastic stockings but also elastic bandages, was verified. In clinical practice, the compression pressure should be selected in consideration of the prospective stiffness.

Comparison of stiffness and interface pressure during rest and exercise among various arm sleeves

OBJECTIVES

To compare the interface pressure during rest and exercise among various kinds of arm sleeves.

METHODS

The interface pressure underneath nine different arm sleeves was measured during 10 maximal opening and closing movements of fingers using a pressure transducer (Air Pack Type Analyser) in 16 healthy volunteers. Furthermore, in order to evaluate the characteristics of each arm sleeve, the extensibility, stiffness and thickness were determined in vitro by several apparatuses.

RESULTS

There was a significant correlation between stiffness and extensibility. The stiffness was significantly correlated with the pressure difference between muscle contraction and relaxation during exercise. The higher the value of stiffness, the greater the pressure amplitude during exercise.

CONCLUSION

Short-stretch arm sleeves characterized with a high level stiffness, including thick round- and flat-knitted arm sleeves, are more beneficial for the augmentation of muscle pumping than long-stretch arm sleeves, in the same way as short-stretch bandages or stockings applied to the leg.

IFNβ-1b may severely exacerbate Japanese optic-spinal MS in neuromyelitis optica spectrum

BACKGROUND

Interferon-β-1b (IFNβ-1b) has been used to prevent exacerbation of relapsing-remitting multiple sclerosis (RRMS) including optic-spinal multiple sclerosis (OSMS) in Japan. We encountered 2 patients with OSMS with unexpectedly severe exacerbation soon after the initiation of IFNβ-1b therapy. The experience urged us to retrospectively review the patients with RRMS who had been treated with IFNβ-1b to identify similar cases.

METHODS

At neurologic departments of 9 hospitals, the medical records of 56 patients with RRMS were reviewed to identify those who showed severe exacerbation soon after the initiation of IFNβ-1b therapy.

RESULTS

Of 56 patients with RRMS, we identified 7 who experienced severe exacerbation (exacerbation with increased scores of Expanded Disability Status Scale ≧7.0) within 90 days of the initiation of IFNβ-1b therapy. In all 7 patients, the exacerbations after the initiation of IFNβ-1b therapy were more severe than those experienced by the individual patients before the use of IFNβ-1b, and seemed to have occurred unexpectedly in a short time after the initiation of INFβ-1b therapy. A retrospective analysis revealed that all 7 patients had antibodies toward aquaporin 4, and the clinical features of all 7 patients after the exacerbation were consistent with those of neuromyelitis optica (NMO) spectrum.

CONCLUSIONS

Our study suggests that IFNβ-1b may trigger severe exacerbation in patients with the NMO spectrum. In INFβ-1b therapy, cases in NMO spectrum should be carefully excluded.

Conservative treatment for patients with intermittent claudication

AIM

The effect of pharmacotherapy or supervised exercise training on patients with intermittent claudication was assessed.

METHODS

One hundred patients with stable intermittent claudication due to arteriosclerosis obliterans were analyzed. We divided the patients into 2 groups: patients treated by pharmacotherapy alone (Group A: 39 claudicants) and patients treated by supervised exercise training and pharmacotherapy (Group B: 61 claudicants). The changes in ankle-brachial pressure index (ABI) and recovery time of ABI after a 40-m walk (RT(40)) and absolute claudication distance (ACD) on a treadmill before and after each treatment were assessed.

RESULTS

In Group A, RT(40) decreased from 9.5 +/- 5.8 min at the baseline to 6.4 +/- 3.5 min after 6 months (P=0.0002). In Group B, it decreased from 9.7+/-5.2 min at the baseline to 6.3+/-4.2 min after 3 weeks (P<0.0001). In Group A, ACD increased from 249+/-177 m at the baseline to 317+/-168 m after 6 months (P=0.0003). In Group B, it increased from 143+/-90 m at the baseline to 257+/-161 m after 3 weeks (P<0.0001).

CONCLUSION

Hemodynamics and walking ability were improved by either short-term supervised exercise training or midterm pharmacotherapy. RT(40) may be useful for predicting the effect of conservative treatment on intermittent claudication. Greater increases in ACD after treatment can be achieved in claudicants with a shorter RT(40) before conservative treatment.

A comparison of interface pressure and stiffness between elastic stockings and bandages

Objectives

To compare the interface pressure during posture changes and exercise between elastic stockings and bandages.

Methods

Using a pressure transducer (air pack-type analyzer), the interface pressures associated with three different elastic stockings and three different elastic bandages were measured during supine resting, standing and exercise in 15 healthy volunteers.

Results

Short-stretch bandages showed a significantly higher static stiffness index value, which is defined as the pressure difference between lying and standing, than long-stretch bandages and short-stretch stockings ( P < 0.001). Furthermore, short-stretch bandages showed a significantly greater pressure difference between muscle contraction and relaxation in both tip-toe and knee-bending exercises than long-stretch bandages and short-stretch stockings ( P < 0.001).

Conclusion

Short-stretch bandages can be expected to have more pronounced benefits for augmenting muscle pump than long-stretch bandages and short-stretch stockings.

Spontaneous spinal epidural haematoma in association with Kasabach-Merritt syndrome

The authors report a case of spontaneous spinal epidural haematoma causing paraplegia secondary to thrombocytopaenia and consumptive coagulopathy from Kasabach-Merritt syndrome. The patient had long-standing multiple subcutaneous and visceral haemangiomas from childhood and developed lumbago and subsequent paraplegia. Evacuation of a spinal epidural haematoma was performed, however, the patient's neurological symptoms did not improve significantly. This case describes the potential risk of bleeding in the spinal column in patients with Kasabach-Merritt syndrome. Prompt diagnosis and management are crucial for an optimal outcome.

Heparin-induced thrombocytopenia complicated with massive thrombosis of the inferior vena cava after filter placement

A 45-year-old man presented with deep vein thrombosis of the right leg and bilateral pulmonary embolism. Heparin was administered on the initial one and a half days. On the 3rd day, an inferior vena cava (IVC) filter was placed with a heparin flush, after which massive IVC thrombosis developed. The platelet count was 221000/mm3, decreased 42% from the initial level, but remained within the normal range. Heparin was replaced by argatroban on the 13th day. The platelet count increased to 355000/mm3 on the 15th day. The patient was positive for antibody against complexes of heparin and platelet factor 4, and was diagnosed as heparin-induced thrombocytopenia with thrombosis syndrome (HITTS). When thrombosis develops during heparin treatment, it is important to suspect HITTs and to assay for the associated antibodies, regardless of the actual platelet count.

Gluteal compartment syndrome after abdominal aortic aneurysm repair

A 66-year-old man underwent emergency surgery for a ruptured abdominal aortic aneurysm associated with right common and internal iliac aneurysms. Postoperatively, his right buttock was distended and tender to compression. A CT scan revealed an extremely swollen right gluteus maximus with decreased density. Macromyoglobinuria was noted, and creatine kinase and myoglobin were elevated: 87,800 IU/l and 144,300 ng/ml, respectively. Renal function had deteriorated and he was treated with hemodialysis until the 15th postoperative day. The patient recovered without any discomfort to the buttock or intermittent claudication. To our knowledge this is the first documented case of gluteal compartment syndrome after the repair of an abdominal aortic aneurysm.

Disappearance of M(r) 25,000 protein, a new protein kinase substrate, in parallel with a kind of serpin during embryogenesis

M(r) 25,000 protein (pp25) is a protein kinase substrate detected recently in Xenopus laevis oocytes [Hashimoto, E. et al. (1995) J. Biochem. 118, 453-460], but the physiological role of this protein remains to be determined. In order to elucidate some characteristics of pp25, a polyclonal antibody was raised against it and the distribution and quantitative changes of this protein were examined using various tissues and biological systems. In Western blot analysis, pp25 was detected only in Xenopus oocytes and not in other frog tissues when the heat-stable cytosolic fraction from each tissue was examined. Although the amount of pp25 apparently did not change during oocyte maturation induced by progesterone, pp25 disappeared in embryos around Nieuwkoop/Faber stages 45-48 in parallel with the change of pNiXa (a kind of serpin). These results suggest that pp25 plays some specific role(s) in Xenopus oocytes and that the level of pp25 changes dramatically during embryonic development.

Indications for and limitations of exercise training in patients with intermittent claudication

BACKGROUND

The selection of candidates for exercise training among patients with intermittent claudication is still a matter of debate.

PATIENTS AND METHODS

Forty-nine patients with intermittent claudication due to arteriosclerosis obliterans were tested. Forty-six patients were men and 3 were women, with an average age of 65 years (range, 46 to 76 years). The patients walked on a treadmill at 2.4 km/h on a 12% upgrade followed by an appropriate period of rest for 30 minutes twice a day during a 3-week hospitalization. Programs were individualized for each patient. Four parameters were assessed after exercise training: (1) Ankle-brachial index (ABI) at rest, (2) Fall in ABI after 40 m of treadmill walking (ABI Fall 40), (3) the recovery time (RT 40) required for the ABI to return to resting levels after 40 m of walking, and (4) the maximal walking distance (MWD) on the treadmill.

RESULTS

The average ABI at rest before the 3-week training period was 0.60 +/- 0.02 (mean +/- SE), and after training it was 0.62 +/- 0.02. There was a small although not statistically significant increase in the ABI after training. This increase in the ABI did not exceed 0.21. The average ABI Fall 40 before training was 0.36 +/- 0.01, and after training it was 0.30 +/- 0.02. The average RT 40 before training was 9.9 +/- 0.8 min, and after training it was 6.2 +/- 0.6 min. There were significant decreases in the ABI Fall 40 and RT 40 after training (p < 0.01 and p < 0.001, respectively). The MWD increased after training in 48 of the 49 patients. The average MWD increased from 134 +/- 13 m to 226 +/- 32 m after training (p < 0.001). The occlusion levels did not influence the results as training effects and hemodynamic parameters. Fourteen of 49 patients desired arterial reconstruction after exercise training.

CONCLUSIONS

Patients with shorter RT 40's before training achieved greater increases in the MWD after training. In patients with an RT 40 under 12 min, exercise training is indicated. However, there is some discrepancy between the increase in MWD and the degree of satisfaction in individual patients.

Detecting odorous materials in water using quartz crystal microbalance sensors

Water drawn from rivers into purification plants must be checked for the presence of odorous materials because oil or organic-solvent contamination of the water may occur. If the detection of odorous materials in water is untimely or fails, the consequences can be serious. Therefore, the water must be checked continuously. We have developed a water-monitoring system that uses a highly sensitive electronic nose consisting of quartz crystal microbalance sensors to detect odorous materials in water. The nose is sensitive enough to detect petroleum hydrocarbons without water vapor at a low-ppb level. However, the nose is very sensitive to humidity and temperature. We have thus developed a method for accurately maintaining the humidity and temperature in the sensor cell. Experimental results show that the developed system can quickly detect contaminated water that was mixed with gasoline, kerosene, or benzene (concentration: several hundred ppb level), and we should be able to classify the pollutant by using pattern recognition of the dynamic sensor response.

Treatment for aortic graft infection

Nine patients with an aortic graft infection presented after undergoing aortic grafting. Seven of 9 patients underwent an initial aortic reconstruction in our hospital. The incidence of aortic graft infection was 1.5% (7/456). There were 6 cases of paraprosthetic infection and 3 cases of aortointestinal fistulas. The treatments consisted of a complete graft excision and an axillofemoral bypass in 6 patients, a complete graft excision alone, a partial graft excision and a femorofemoral bypass, and the preservation of the graft with omental wrapping and irrigation in 1 each. Broad-spectrum antibiotics were intravenously administered to all patients and were then replaced by selective antibiotics for the responsible organisms. All surviving patients received antibiotics orally for 3-6 months. The early postoperative mortality rate was 11.1%. Aortoduodenal fistula occurred in 1 patient with graft excision alone. Graft thrombosis occurred in 2 patients with an axillofemoral bypass. No late graft infection or stump blowout occurred in any patient. We believe that a complete excision of the infected graft as well as the maintenance of distal tissue perfusion is necessary. However, based on the condition of the patient, the appearance of the operating field, and the difficulty of a repeat operation, we would like to stress the importance of selecting the best and safest treatment plan for each case.

Usefulness of HMG-CoA reductase inhibitor in Japanese hyperlipidemic women within seven years of menopause

OBJECTIVE

To assess the therapeutic value of treatment with an HMG-CoA reductase inhibitor in women with hypoestrogenic hyperlipidemia caused by menopause.

DESIGN

Fifty-six women with total cholesterol (TC) levels of 220 mg/dl or more who were within 7 years of menopause were randomly assigned to receive an HMG-CoA reductase inhibitor (pravastatin 10 mg/day; treated group, 26 patients) or no medical treatment (nontreated group, 30 patients) in this 6-month nonblinded prospective trial.

RESULTS

In the treated group, the mean (SD) TC levels decreased significantly from 254.5+/-22.3 mg/dl at baseline to 204.7+/-22.2 mg/dl (19.6%), and the mean low-density lipoprotein cholesterol (LDL-C) level decreased significantly from 146.7+/-30.5 to 104.3+/-22.5 mg/dl (28.9%); the mean arteriosclerotic index decreased significantly from 2.98 to 2.08 (30.2%). There were no significant changes in either triglyceride levels or high-density lipoprotein cholesterol (HDL-C) levels. In the nontreated group, there were no significant changes in the TC, HDL-C, LDL-C, or triglyceride levels; there was also no change in the arteriosclerotic index. After 6 months, the TC level, LDL-C level, and arteriosclerotic index were significantly lower in the treated group compared with the nontreated group (p<0.01).

CONCLUSIONS

The results indicate that the HMG-CoA reductase inhibitor lowered TC and LDL-C levels and was useful in the treatment of hypoestrogenic hyperlipidemia for periods of at least 6 months.

A serpin with M(r) 43,000 is a binding protein of M(r) 25,000 protein, a substrate for protein ser/thr kinase detected in Xenopus laevis oocytes

In an attempt to get some clue as to the function of M(r) 25,000 protein, a protein Ser/Thr kinase substrate detected in Xenopus laevis oocytes [Hashimoto, E. et al. (1995) J. Biochem. 118, 453-460], the binding protein was surveyed using the (32)P-labeled protein by casein kinase II as a screening probe. When the cytosolic proteins from oocytes were transferred to a polyvinylidene fluoride membrane and incubated with the labeled protein, only one protein with M(r) 43,000 was visualized on autoradiography. This protein was purified to a nearly homogeneous state through several column chromatography steps. The amino acid sequence of the amino-terminal region of this protein identified it as a kind of serine protease inhibitor (serpin) [Holland, L.J. et al. (1992) J. Biol. Chem. 267, 7053-7059]. However, the M(r) 25,000 protein did not have any effect on the inhibitory action of this serpin on alpha-chymotrypsin. In addition, several binding proteins were also detected in the particulate fraction of oocytes, although the exact identity of these proteins is not clear at this time. These results suggest that the M(r) 25,000 protein may play some role(s) by interacting with these binding proteins in Xenopus oocytes.

Synthesis of pyrimidine 2'-deoxy ribonucleosides branched at the 2'-position via radical atom-transfer cyclization reaction with a vinylsilyl group as a radical-acceptor tether

Recently, we developed a regio- and stereoselective method for introducing a vinyl group at the position beta to a hydroxyl group in halohydrins or alpha-phenylselenoalkanols via a radical atom-transfer cyclization reaction with a vinylsilyl group as a temporary connecting radical-acceptor tether. The synthesis of 2'-deoxy-2'-C-vinyl- and 2'-deoxy-2'-C-hydroxymethyluridines (7 and 8, respectively) and the corresponding 2'-deoxycytidine congeners (10 and 11, respectively), which were designed as potential antitumor and/or antiviral agents, was achieved using this radical atom-transfer cyclization as the key step. When the 2'-deoxy-2'-iodo-5'-O-monomethoxytrityl (MMTr) uridine derivative 19a, bearing a vinylsilyl group at the 3'-hydroxyl group, was heated with (Me(3)Sn)(2) and AIBN in benzene, the corresponding radical atom-transfer product was generated, which in turn was successively treated with tetrabutylammonium fluoride and TBSCl/imidazole to give the desired 2'-deoxy-5'-O-MMTr-3'-O-TBS-2'-C-vinyluridine (25). Compound 25 was successfully converted into the target 2'-deoxy-2'-branched pyrimidine ribonucleosides 7, 8, 10, and 11.

Algal-lytic activities encoded by Chlorella virus CVK2

Using a halo assay with E. coli lysates expressing Chlorella virus CVK2 genes on a cosmid contig, two different algal-lytic activities against Chlorella strain NC64A cells were found to be encoded on the CVK2 genome. The gene for vAL-1, one of the two activities, encoded a 349-aa ORF, which was homologous to PBCV-1 A215L and CVN1 CL-2. The vAL-1 gene was expressed at relatively early stages of the virus life cycle; transcripts and translation products appeared at 60 and 90 min postinfection, respectively. The vAL-1 protein was not incorporated into the viral particles but remained in the cell lysate, suggesting a role in the digestion of the cell wall before viral release at the final stage of infection. Cell wall materials isolated from Chlorella strain NC64A cells were digested by vAL-1 and degradation products were detected on TLC. In addition to Chlorella strain NC64A, vAL-1 lysed cells of four C. vulgaris strains as well as Chlorella sp. SAG-241-80.

[Surgical treatment for infective endocarditis with multiple embolic complications]

A 59-year-old man was transferred to our hospital because of severe right leg pain, dyspnea and anuria. Due to severe cyanosis of the legs below the knees and severe hyperkalemia, he had undergone embolectomy of the right femoral artery and hemodialysis. Medical treatment for infective endocarditis was started after the first operation, because transesophageal echo cardiography revealed severe aortic regurgitation and massive vegetation of the aortic valve. Amputation of the right leg below the knee and of the left leg below the Lisfranc joint was performed after 19 days and aortic valve replacement with patch closure of a perivalvular abscess was performed one month after the first operation. The post-operative course was uneventful. He was weaned from hemodialysis and the follow-up echocardiographic study revealed no vegetation.

(-)-Epigallocatechin gallate inhibits mos activation-mediated xenopus oocyte maturation induced by progesterone

(-)-Epigallocatechin gallate (EGCG), one of the constituents of green tea known to have a tumor preventing effect, inhibited maturation of Xenopus laevis oocytes induced by progesterone when this polyphenol was microinjected into oocytes at a final concentration of about 1 mM. Western blot and activity measurement analyses showed that Mos translation and the subsequent activations of mitogen-activated protein kinase and p90(rsk), probably by protein phosphorylation, seemed to have been inhibited by the microinjection of EGCG. These results suggest that EGCG may have the ability to control Xenopus oocyte maturation at least during the stage of Mos activation.

Odorant detection capability of QCR sensors coated with plasma deposited organic films

Odorant-detection experiments were conducted on major single-odor substances in various types of botanical species. The sensing devices we used were quartz-crystal resonators (QCRs), radio-frequency (RF) sputtered with amino acids or polymers. The odorants were generated at very low concentrations (ppb level) by using the diffusion-tube method. The tested odorants were detected at concentrations between 0.3 and 940 ppb. These deposited films had high partition coefficients for the odorants, confirming their high sensitivity to organic vapors, especially to terpenoids. This indicates that the odorant solvation is due to odorant-film interaction related to Gibbs free energy.

Detection of petroleum hydrocarbons at low ppb levels using quartz resonator sensors and instrumentation of a smart environmental monitoring system

Petroleum hydrocarbon vapors at low ppb levels can be detected using a thickness shear mode resonator (TSMR) coated with a chemical-sensing overlayer, prepared by radiofrequency sputtering of porous sintered-polyethylene (PS-PE). The sensing capabilities of PS-PE sensors were profoundly affected by the sputtering methods; they were enhanced by the photo-excitation effect, and were reduced by carbonization and water treatment. The photo-assisted PS-PE sensor was extremely sensitive and could detect linear hydrocarbon (> C12) vapors below the ppb level. The time constant of the sorption curve, however, was large, indicating a slow sensing speed. Toward creating instrumentation for a smart environmental monitoring system, the TSMR sensors were arrayed on a circuit board equipped with a serial interface and signal processing chips of the oscillation drive and frequency counter. Co-sorption with water vapor at a relative humidity of about 10% has almost no effect on the sensing ability of PS-PE sensors for 1,2,4-trimethylbenzene. Conversely, it enhances the sensitivity of the TSMR sensor coated with a D-phenylalanine film. Upward shifts in the baseline are evident with elapsed time. However, a rigorous ten-cycle iteration test for 100 ppm toluene vapor demonstrated good reproducibility of the sensor's signals.

Protective effect of a vasopressin-1 selective antagonist, OPC-21268, against ethanol-induced damage of the rat gastric wall

Since endogenous vasopressin has been reported to be an aggressor in the gastric mucosa and a vasoconstrictor in the gastric circulation, we investigated the gastric cytoprotective effects of OPC-21268, a newly developed, nonpeptide, orally active vasopressin-1 receptor antagonist, on ethanol-induced gastric injury in rats. The rats were treated with OPC-21268 or placebo 2 hr before ethanol administration, and the gastric mucosa was evaluated macroscopically for ulcer damage, and histologically for gastric mucosal injury. Gastric mucosal blood flow, erythrocyte volume, and erythrocyte velocity were also measured in groups given saline, ethanol alone, and ethanol after OPC-21268. To investigate the role of systemic or locally secreted vasopressin, we measured plasma and tissue (gastric mucosa) vasopressin concentrations after ethanol or vehicle administration. Prophylactic OPC-21268 treatment improved the gastric ulcer score in a dose-dependent manner, and histological examination demonstrated that the drug significantly ameliorated the gastric injury induced by ethanol. The hemodynamic values obtained in the OPC-21268-treated and ethanol-treated group were similar to those in the saline control group, but values were significantly (P < 0.05) higher for gastric mucosal blood flow and erythrocyte velocity and lower for erythrocyte volume compared to the group given ethanol alone. Plasma vasopressin concentrations were not significantly different in the control group and at 15, 30, and 60 min after administration of ethanol. However, ethanol administration caused a threefold increase in gastric tissue vasopressin level (P < 0.05) compared to the control group. These results suggested that OPC-21268 relieved congestive hyperemia in the gastric mucosa and ameliorated the mucosal injury caused by ethanol, probably as a result of inhibition of vasopressin-mediated actions on the stomach. The vasopressin involved was probably generated locally in the gastric mucosa after ethanol administration.

Nucleosides and nucleotides. 183. Synthesis of 4'alpha-branched thymidines as a new type of antiviral agent

A series of 4'alpha-branched thymidines was synthesized and evaluated as potential antiviral agents. 4'-Ethylthymidine (3), 4'-ethenylthymidine (5), and 4'-ethynylthymidine (6) exhibited potent anti-HSV-1 and anti-HIV-1 activities with no significant cytotoxicity.

Possible role of alteration in pH, but not in ionic strength, in the modulation of Ca(2+)-dependent and diacylglycerol-induced association of protein kinase C-alpha with plasma membrane

In an attempt to elucidate the mechanism of the membrane binding of protein kinase C-alpha (PKC-alpha), effects of pH and ionic strength were examined on Ca(2+)-dependent and diacylglycerol-induced association of this PKC with rat liver plasma membrane. In the absence of diacylglycerol, the membrane-bound PKC-alpha increased according to the changes in pH from 6 to 8. However, these reactions were not seriously influenced by alterations in ionic strength (0-240 mM NaCl). In the presence of diacylglycerol, this pH-modulated binding of PKC-alpha to plasma membrane was more effective under lower Ca2+ concentration at pH 8. These results suggest that alkaline pH conditions seem to be important for preferable association of PKC-alpha with plasma membrane.

Role of endogenous endothelin in the development of graft arteriosclerosis in rat cardiac allografts: antiproliferative effects of bosentan, a nonselective endothelin receptor antagonist

BACKGROUND

The purpose of this study was to determine whether endothelin-1 (ET-1) contributes to the development of graft arteriosclerosis and whether the orally active nonpeptide endothelin receptor antagonist bosentan, which blocks both ETA and ETB receptors, can protect against this pathologic damage.

METHODS AND RESULTS

Recipient male Lewis rats were divided into three groups; group 1 received heterotopic heart transplantations from Lewis donors and groups 2 and 3 received transplantations from Brown-Norway donors; group 3 recipients also received bosentan orally at the dose of 20 mg/kg per day for 120 days. All recipients were given cyclosporine and were euthanized at examination 120 days after transplantation. Plasma ET-1 levels were significantly higher in group 2 than in group 1 (6.99+/-0.91 and 4.15+/-.83 pg/mL, respectively). Strong ET-1 immunoreactivity was seen in both the thickened neointima and the media of the coronary arteries in group 2 but not in group 1. The mean ratio of the coronary luminal area to the total vascular area in group 2 (19.0+/-11.7%) was significantly lower than that in group 1 (34.2+/-9.9%) and was significantly increased in group 3 (33.2+/-9.2%).

CONCLUSIONS

These results show that local upregulation of ET-1, mainly in the thickened neointima and the media of the coronary arteries, may play an important role in the pathogenesis of graft arteriosclerosis by stimulating ETA receptors, ETB receptors, or both. Orally active bosentan might be a useful agent for the clinical prevention of graft arteriosclerosis.

Effect of a HMG-CoA reductase inhibitor combined with hormone replacement therapy on lipid metabolism in Japanese women with hypoestrogenic lipidemia: a multicenter double-blind controlled prospective study

OBJECTIVES

Menopause is associated with a rise in serum lipid concentrations. We compared a regimen of pravastatin alone with pravastatin and hormone therapy in postmenopausal women with hyperlipidemia.

METHODS

We performed a double-blind, randomized, multicenter controlled study in postmenopausal women with hyperlipidemia. The women were randomly assigned to receive pravastatin alone (M group; n = 25) or pravastatin and hormone replacement therapy (HRT) (MC group; n = 32) for 12 weeks. Serum lipid and estrogen concentrations were measured at baseline and after 4 weeks and 12 weeks of treatment.

RESULTS

The two groups were similar with respect to baseline demographic characteristics such as age, height, and body weight. As compared with baseline, the total cholesterol (TC) concentration was 15.0% lower at 4 weeks and 17.7% lower at 12 weeks in the M group and 15.1% lower at 4 weeks and 18.3% lower at 12 weeks in the MC group. The low-density-lipoprotein cholesterol (LDL-C) concentration decreased by 25.0% at both 4 weeks and 12 weeks in the M group and by 26.8% at 4 weeks and 30.0% at 12 weeks in the MC group. Serum TC and LDL-C concentrations were significantly lower in the MC group than in the M group after 4 weeks of treatment, but there was no significant difference between the groups in serum lipid concentrations after 12 weeks. Pravastatin combined with HRT was therefore suggested to lower serum lipid concentrations earlier than pravastatin alone. There were no significant differences between the treatment groups in serum high-density-lipoprotein cholesterol concentrations or triglyceride concentrations after the initiation of therapy. In the MC group, there was a significant positive correlation between the percentage change in serum lipid concentrations and that in estrogen concentrations, suggesting that the HRT-induced rise in estrone (E1) as well as that in estradiol (E2) contributed an improved serum lipid profile. TC and E2, and LDL-C and serum E1 had significant negative correlation at 12 weeks and 4 weeks, respectively. Pravastatin had no apparent effect on endogenous estrogen levels and was not associated with any side effects, which confirmed that pravastatin is safe, either alone or in combination with HRT.

CONCLUSIONS

The combination of pravastatin and HRT in the management of hyperlipidemia in postmenopausal women is very useful therapeutically, because it additionally provides the broad benefits of HRT, without compromising the lipid lowering effects of either treatment.

Limb salvage and survival rates among elderly patients with advanced limb ischemia

The purpose of this study was to clarify the incidence of limb salvage and patient survival rates among elderly patients with advanced leg ischemia. We reviewed the records of 159 patients treated for advanced ischemia over a 15-year period at Aichi Medical University, 74 of whom were aged over 75 years and 85, between 65 and 74 years. There was a collective total of 186 limbs; 82 in the older group and 104 in the younger group. The older group had a greater proportion of women, and a higher incidence of coronary heart disease, pulmonary dysfunction, and acute onset of advanced ischemia than the younger group. Limb salvage was achieved in 73% of the affected limbs in the older group and in 92% of the limbs in the younger group. The poor limb salvage rate in the older group was mainly related to the high initial amputation rate. Early recognition of the sentinel ischemic signs before the ischemia is essential, especially in the elderly. Timely revascularization should be attempted whenever possible, and it should not be abandoned simply because the patient is deemed too old. The 1-, 3-, and 5-year survival rates in the older group were 59%, 28%, and 23%, respectively, which were markedly poorer than the expected survival rates of the age- and sex-matched Japanese population at 1, 3, and 5 years, which were 93%, 79%, and 65%, respectively. Thus, advanced limb ischemia carries a poor prognosis to the point of being life-threatening, and further continuous systemic management with the collaboration of physicians and surgeons must be provided even after the patient has left the hospital.

Down-regulation of protein kinase C-alpha detected in human colorectal cancer

The down-regulation of protein kinase C (PKC) was examined by Western blot procedure on about 30 tissue samples derived from human colorectal cancer and the corresponding normal mucosa. PKC-alpha down-regulation was detected in 60% of the cancer tissues compared with the respective normal mucosa and was observed in a higher frequency with the tissues under more advanced cancer stages. However, the frequencies of the down-regulation of PKC-delta and PKC-zeta were lower than that of PKC-alpha. These results suggest that a decreased level of PKC-alpha may affect the cell growth and tumor promotion in colorectal tissue.

The gain of the hepatorenal reflex in anesthetized dogs

To determine the overall gain of the hepatorenal reflex, hypertonic NaCl solutions were infused into the portal vein or inferior vena cava of anesthetized dogs at a rate of 0.01 ml/kg/min for 30 min and the urinary Na excretion measured. Infusion of 2.25% NaCl into either the portal vein or inferior vena cava had no effect. Portal infusion of 4.5% or 9% NaCl produced an increase of 36 +/- 16 or 40 +/- 17 microeq/kg/30 min, respectively, while inferior vena caval infusion had no effect. With 13.5% NaCl infusion, a significant increase in the natriuretic response was seen with portal venous infusion, with no significant difference between portal venous and inferior vena caval infusion. Thus, the difference in the natriuretic response between portal venous and inferior vena caval infusion was dependent on the degree of input; when an appropriate input was given, natriuresis was induced only by portal venous infusion, probably mediated by the hepatorenal reflex. The gain of the hepatorenal reflex was calculated from the output divided by the input. When 4.5% or 9% NaCl was infused into the portal vein, the 2-h gain of the hepatorenal reflex was 0.38 +/- 0.15 or 0.34 +/- 0.14, respectively.

Chylous reflux into the lower limb with septic shock successfully treated by resection of the retroperitoneal megalymphatics

A 15-year-old boy with primary chylous reflux into the left lower limb with septic shock was successfully treated by en bloc resection and ligation of the retroperitoneal megalymphatics. The episode of chyle discharge from the lower limb and/or genitalia and the presence of small vesicles of the skin may be an important sign in diagnosing chylous reflux. Surgical interruption of the chylous reflux and reduction of girth may be needed.

Suppression of renal sympathetic nerve activity during portal vein infusion of hypertonic saline

Sodium ions absorbed from the intestine are postulated to act on the liver to reflexly suppress renal sympathetic nerve activity (RSNA), resulting in inhibition of sodium reabsorption in the kidney. To test the hypothesis that the renal sympathoinhibitory response to portal venous NaCl infusion involves an action of arginine vasopressin (AVP) at the area postrema, we examined the effects of portal venous infusion of hypertonic NaCl on RSNA before and after lesioning of the area postrema (APL) or after pretreatment with an AVP V1 receptor antagonist (AVPX). Rabbits were chronically instrumented with portal and femoral venous catheters, femoral arterial catheters, and renal nerve electrodes. Portal venous infusion of 9.0% NaCl (0.02, 0.05, 0.10, and 0.15 ml.kg-1.min-1 of 9.0% NaCl for 10 min) produced a dose-dependent suppression of RSNA (-12 +/- 3, -34 +/- 3, -62 +/- 5, and 80 +/- 2%, respectively) that was greater than that produced by femoral vein infusion of 9.0% NaCl (2 +/- 3, -3 +/- 2, -12 +/- 4, and -33 +/- 3%, respectively). The suppression of RSNA produced by portal vein infusion of 9.0% NaCl was partially reversed by pretreatment with AVPX (-9 +/- 3, -20 +/- 3, -41 +/- 4, and -55 +/- 4%, respectively) and by APL (-11 +/- 2, -25 +/- 2, -49 +/- 3, and -59 +/- 6%, respectively). There were no significant differences between the effects of AVPX and APL, and the effect of APL was not augmented by AVPX. These results indicate that the suppression of RSNA due to portal venous infusion of 9.0% NaCl involves an action of AVP via the area postrema.

A new surgical technique for the treatment of life-threatening congenital arteriovenous malformation--intraluminal graft implantation

A new surgical intraluminal graft implantation technique was undertaken in a 27-year-old man with a massive, life-threatening, high-flow congenital arteriovenous malformation (AVM) involving the left lower extremity, which was resistant to such challenges as transarterial embolizations or partial resections. For occlusion of the feeder branches, a composite graft composed of two grafts with different diameters, which matched to the arterial lumen, was surgically inserted into the superficial femoral artery. The implanted graft occluded 2 weeks after the insertion. Although amputation distal to the knee was necessary because of the foot necrosis, the graft was useful in reducing the cardiac output (from 14.3 l/min to 9.8 l/min) and obviating hip joint amputation. A further clinical study is necessary to examine whether or not it is an acceptable treatment modality.

Tacalcitol (1,24(OH)2D3, TV-02) inhibits phorbol ester-induced epidermal proliferation and cutaneous inflammation, and induces epidermal differentiation in mice

In this study, we examined the cutaneous effects of tacalcitol [1,24(R)(OH)2D3] on epidermal proliferation, differentiation, and skin inflammation in vivo using hairless mice. Tacalcitol was shown to inhibit epidermal proliferation using TPA-induced ornithine decarboxylase activity and DNA synthesis as indices, and the induction of epidermal differentiation using type I transglutaminase activity as an index. Tacalcitol also displayed an antiinflammatory effect on TPA-induced inflammatory changes histopathologically. These results confirm the clinical efficacy of tacalcitol in psoriasis, and suggest that it may be efficacious in the treatment of other inflammatory skin diseases.

Decreased bone mineral density associated with early menopause progresses for at least ten years: cross-sectional comparisons between early and normal menopausal women

To establish whether early onset of menopause carries an increased risk of osteoporosis, we compared the bone mineral density (BMD) of the second to fourth lumbar vertebrae (L2-4) between 18 women who had menopause before 43 years of age (early menopause group) and 19 women who had menopause after reaching 43 years of age (normal menopause group). Serum levels of calcium, phosphorus, calcitonin, intact parathyroid hormone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), and alkaline phosphatase activity were measured, and urine samples were analyzed to derive calcium/creatinine, hydroxyproline/creatinine, pyridinoline/creatinine, and deoxypyridinoline/creatinine (D-Pyr/Cr) ratios. Mean BMD was significantly lower in the early menopause group than in the normal menopause group, and individual BMD values in about half of the subjects in the former group were below the fracture threshold for Japanese women. Serum concentrations of LH, FSH, and E2 were slightly, but not significantly, lower in the early menopause group than in the normal menopause group. The D-Pyr/Cr ratio was significantly higher in the early menopause group than in the normal menopause group. There was no correlation between L2-4 BMD and age or the number of years after menopause in the normal menopause group, but both age and the number of years after menopause were negatively correlated with L2-4 BMD in the early menopause group. These results indicate that BMD in women who have early menopause continues to decline for up to 10 years, and that menopause and aging increase the risk of osteoporosis.

The effect of 1,24(R)(OH)2D3 cream and ointment on epidermal proliferation and differentiation in mice

BACKGROUND

The 1,24(R)(OH)2D3 (tacalcitol) ointment (2 micrograms/g) is available commercially as an antipsoriatic drug in Japan, but the cream preparation of tacalcitol is still under development.

OBJECTIVE

This study was conducted to compare the ability of tacalcitol cream and ointment to inhibit epidermal proliferation and induce epidermal differentiation.

METHODS

We measured the ornithine decarboxylase activity and type I transglutaminase activity as indices of proliferation and differentiation, respectively, in hairless mice.

RESULTS

These effects were statistically equal to those of the ointment preparation at the same dose, 2 micrograms/g, without inducing hypercalcemia.

CONCLUSIONS

These findings suggest that topical application of 1,24(OH)2D3 cream (2 micrograms/g) might have the same potency as the ointment formulation in the treatment of psoriasis.

Benefits of arterial reconstruction in claudication

We conducted a midterm follow-up of 150 claudicants who underwent surgical reconstruction by assessing cumulative patency, survival, and palliation (graft patency in live patients) rates. Eighty-nine claudicants (group I) underwent direct (in situ) proximal revascularization, 33 (group II) had indirect (ex situ) proximal revascularization, while 28 (group III) had distal revascularization. The secondary patency rates at 3 years were 97.5% in group I, 97.0% in group II, and 75.0% in group III, respectively. Only one patient with limb graft thrombosis required below-knee amputation. There were 3 perioperative deaths (2 in group I and 1 in group II). The survival rates at 3 years were 86.0% in group I, 69.5% in group II, and 95.8% in group III, respectively. The palliation rates at 3 years were 84.8% in group I, 70.0% in group II, and 77.9% in group III, respectively. These findings indicate the midterm benefits of supra- and infrainguinal arterial reconstructions, and also suggest that the preoperative assessment of risks in individual patients, the selection of the appropriate operative procedure and graft material, and intensive postoperative follow-up and management of any associated disease are all important aspects in the treatment of claudicants.

Alendronate modulates osteogenesis of human osteoblastic cells in vitro

The bisphosphonates, which are carbon-substituted pyrophosphates, have been studied extensively both in vivo and in vitro to elucidate their effects on bone tissues and cells. However, because these agents were shown to have a potent inhibitory effect on bone resorption, the majority of studies have focused on only this aspect of bone metabolism. There appears to be less information regarding the direct effect of bisphosphonates on bone formation, so thus we undertook experiments to investigate the effects of bisphosphonates, especially alendronate, on the mineralization and matrix protein synthesis of human osteoblastic cells in vitro. The data show that the bisphosphonates, alendronate, etidronate and pamidronate, suppressed 1,25-dihydroxycholecalciferol (1,25(OH)2D3)-stimulated mineralization of human osteoblastic cells at high concentrations, while relatively lower concentrations of alendronate and etidronate potentiated mineralization of the cells in the presence of 1,25(OH)2D3. The potentiation of mineralization with alendronate was accompanied by increased synthesis of bone matrix proteins, osteocalcin and collagen, and the mRNA of pro alpha(I) collagen. These findings show that in addition to their well-known effects on bone resorption, bisphosphonates have significant and direct effects on osteogenesis in osteoblasts in vitro. The actual mechanism remains to be further investigated.

Recurrence of cystic adventitial disease in an interposed vein graft

A case of cystic adventitial disease (CAD) of the popliteal artery with intermittent claudication in the left calf is reported. This patient was first treated by total excision of the cyst and the involved artery followed by graft interposition with an autogenous saphenous vein. Recurrence of CAD in the interposed vein graft was noted after 6 months, and excision of the cyst with the involved graft and graft interposition with an autogenous saphenous vein was again required. We consider that the definitive evidence from early recurrence in the interposed vein graft shown in this case will close the discussion of the cause of CAD. The cystic lesion is thought by some to originate from the adventitia; traumatic, embryologic, or systemic abnormality theories were proposed. We assume that the mucin-secreting synovial cells originating from the neighboring joint capsule, tendon sheath, or, in some cases, from the ganglion itself, directly invade the adventitia through any rough or injured crack caused by trauma to the adventitia or simply attach to and encircle the adventitia. Total resection of the lesion with grafting is the recommended treatment for CAD because of the excellent results. However, as shown in our case, complete removal of the synovial cells even by resection technique may be difficult; therefore intensive follow-up is fundamentally necessary in this disease.

[Additional palliative operation and staged definitive operation for pulmonary atresia with intact ventricular septum]

Between 1981 and 1992, 38 consecutive patients underwent initial operation for pulmonary atresia with intact ventricular septum. Transpulmonary valvotomy using balloon occlusion of RV outflow was carried out in 24 patients at a mean age of 20 days. An additional Blalock-Taussig shunt was required in 4 patients early in the series. Based on a retrospective review on the patients early in the series, initial palliative procedure had been decided in conformity with the value of an index of RV development (RVDI) = RVEDV% x TVD% x RVODmm/BSAm2 x 10(-5), and recent 3 patients with RVDI < 0.35 and patent RV outflow underwent concomitant valvotomy and Blalock-Taussig shunt. Fourteen patients with muscular atresia of RV outflow or major sinusoidal coronary artery communication underwent Blalock-Taussig shunt. There were 1 operative and 3 late deaths and second Blalock-Taussig shunt was required in 6 patients. Definitive repair was carried out in 20 patients between 1985 and 1994. Fifteen patients with RVEDV > 30% of normal had biventricular repair (partial closure of ASD in 6) and 5 underwent Fontan type repair. In terms of the definitive procedures, when the RV.TV index (= RVEDV% x TVD% x 10(-4)) is greater than 0.4, complete repair should be performed. When the index is between 0.2 and 0.4, the atrial septal defect should only be partially closed when the outflow tract is reconstructed. In those cases with an index of less than 0.2, the Fontan procedure seems to be a procedure of choice.

[Forms of an in vivo polymerization product, n-butyl-2-cyanoacrylate, within the gastric wall]

The in vivo morphology of sclerosants, n-butyl-2-cyanoacrylate (Histoacryl; referred hereinafter to briefly as HA) polymer formed within the gastric wall was investigated in an animal experiment. The results indicate that HA polymer formed after local injection of HA into the stomach wall with deliberate avoidance of contact with blood got scattered in an arboroid pattern, suggesting thus that when HA is injected into the gastric mucosa at an extravascular site, the resulting polymer is likely to get scattered and miss the target site. Polymerization products that were formed after injection of HA alone were deep purple, dense, firm, rounded in shape and lesser in adverse histologic influence upon the walls of stomach. On the other hand, those formed by injection of HA with Lipiodol were large-sized, light brown and oval-shaped ones with more irregular margins and less distinct boundaries as compared to those seen after injection of HA alone. These results of the study led us to conclude that at the present time it would seem wise to limit the use of HA for this particular therapeutic purpose only to those cases of bleeding gastric varices.

[Acute aortic dissection in a patient with Marfan's syndrome and severe pectus excavatum--emergency surgical repairs of ascending aortic dissection and aortic regurgitation complicated by pectus excavatum in Marfan's syndrome]

A case of acute aortic dissection Stanford Type A occurring in a patient with Marfan's syndrome, complicated with aortic regurgitation and severe pectus excavatum, is reported with successful surgical correction. The patient was a 33-year-old woman, who suffered from severe back pain riding to work. An emergency operation consisting of Cabrol's procedure for aortic dissection Stanford Type A and sternal turnover for pectus excavatum was performed simultaneously. Because of the postoperative mediastinal bleeding the implanted sterno-costal complex was removed on the second POD and the prosthetic sternum was reimplanted on the tenth POD. The two-stage operation seems preferable in such an emergency case to avoid postoperative bleeding and infection.

[A study on endoscopic hemostasis from the viewpoint of morphologic traits of Dieulafoy ulcer--an attempt at endoscopic hemostasis by local injection of aethoxysklerol and ethanol]

Characteristics of the vascular course of ruptured vessels in the submucosal layer of Dieulafoy ulcer were studied, and endoscopic hemostatic treatment was performed using Aethoxysklerol and ethanol. 1) Observations of vessel courses in serial sections revealed that ruptured vessels in Dieulafoy ulcer exhibit rhexis in the lateral portions of the vessel and long courses over the ulcer margin in the submucous layer. 2) More dependable hemostasis seemed to be provided by thrombosis not only at the source of bleeding. i.e., at the site of vessel rupture, but also in the region of the whole ruptured vessel in the submucous layer. 3) Hemostatic treatment by local injection of Aethoxysklerol and ethanol was performed in 4 patients with Dieulafoy ulcer, and complete hemostasis was achieved in all 4 patients.

Quantitative design for photostabilization of nifedipine by using titanium dioxide and/or tartrazine as colourants in model film coating systems

The photostabilization of nifedipine by using film coating has been investigated in model systems in which a drug sample, dispersed on a glass plate, was covered with a free film and exposed to intensive light of mercury vapour lamp. The light transmission properties of films containing titanium dioxide or tartrazine alone as colourant were not always satisfactory. The tartrazine system exhibited superior light transmission properties to the titanium dioxide system at all additive concentrations. However, in combination both colourants gave much better light protection than did the colourants separately. The film-coated drug degraded following apparent first-order kinetics. The degradation rate constant decreased as both colourant concentration and film thickness increased; thus photostabilization was almost completely achieved by applying a film (thickness: 60 microns) of the binary mixture system containing only 0.7% of each of these colourants. The protective effectiveness of a film could be quantitatively evaluated by plotting the degradation rate constant against CL value of film formulation (C: concentration of colourant; L: film thickness). The degradation rate constant showed a good linear correlation with the average percent transmittance of a film in the wavelength range relating to the photolytic degradation of the drug. The average percent transmittance was thus proved to be an important and useful parameter for estimating the photostability of film-coated drugs.

Quantitative analysis of trazodone hydrochloride in tablets by an ion-selective electrode

A simple assay procedure for the quantitation of trazodone hydrochloride in tablets, without prior separation, has been developed using a trazodone-selective electrode. The electrode was based on a trazodone:tetrakis(p-chlorophenyl)borate ion-pair complex, dioctyl phthalate, and polyvinyl chloride matrix that were mounted on a PTFE membrane. The electrode showed a near-Nernstian response in the range of 10(-2) to 5 x 10(-6) M trazodone over the pH range of 2.5 to 5.0, with a cationic slope of 58 mV/concentration decade. The durability of the electrode and the reproducibility of the performance among the electrodes were sufficient. The electrode was used for the determination of the pKa value of trazodone. The selectivity of the electrode to a number of interferences was investigated. Many inorganic cations (alkali and alkaline earth metals) and pharmaceutical excipients did not interfere, but some organic ammonium compounds interfered according to their extractability. Determination of 10 to 3000 micrograms/mL of trazodone hydrochloride in aqueous solution showed an average recovery of 100.6% (mean standard deviation 0.4%) by direct potentiometry. This assay was applied to determine trazodone hydrochloride in tablets and the results compared favorably with those obtained by high-performance liquid chromatography.