[A case of transfusion-related acute lung injury following platelet transfusion during the cervical supine surgery]

We report a case of possible transfusion-related acute lung injury (TRALI). The patient is a 69-year-old man who underwent cervical supine surgery Platelet products were transfused pre-and intra-operatively. At the end of the operation, he was fully awake and extubated. Shortly after extubation he showed low oxygen saturation, and we started bag-mask ventilation. A chest X-ray revealed bilateral diffuse pulmonary edema without cardiac enlargement. Thus we inserted endotracheal tube and started positive pressure assist ventilation. Hypoxemia was improved gradually, and he was re-extubated on the fourth day after the operation. The prevalence of TRALI reactions is reported to be high for platelet product and is influenced by patients' underlying clinical condition. Serum anti-leukocyte antibody was negative, but we suspected the possibility of TRALI based on the clinical findings.

[A case of acute exacerbation of interstitial pneumonia after appendectomy managed with spinal anesthesia]

An 88-year-old woman was admitted with acute appendicitis. She had been treated with prednisolone and home oxygen therapy for interstitial pneumonia. Her respiratory state on admission was Grade 2 of Hugh-Jones' classification, and plasma KL-6 and SP-D levels were high. Seven days after the admission, appendectomy was performed under spinal anesthesia. Spinal anesthesia was initiated by injecting 0.5% hyperbaric bupivacaine 2.0ml into L3-4 interspace, and achieved block level was up to T4. During the operation, her respiratory state was stable, but after the operation, dry cough, increase of body temperature, and dyspnea were observed. Chest roentgenogram revealed severe ground glass appearance and reticular shadows bilaterally. Steroid therapy for acute exacerbation of interstitial pneumonia was initiated, but she died on the 13th POD. This case teaches us to take a lot of care in the management of a patient with high plasma level of KL-6 and SP-D.

[Perioperative management of neuroleptic malignant syndrome in a schizophrenic patient scheduled to undergo operation for bowel obstruction]

Neroleptic malignant syndrome (NMS) is a serious side effect of antipsychotic medications. The risk factors for NMS are the patient's physiologic conditions such as dehydration, malnutrition, stress, and additional administration of sedative drugs including haloperidol. We report a case of 62-year-old schizophrenic man with bowel obstruction due to rectal cancer. Colostomy under general anesthesia was scheduled, and he had not taken oral medication. After intravenous injection of haloperidol for sedation, muscle rigidity, high fever, and an elevated serum level of creatine phosphokinase were observed. He was diagnosed as NMS, and sodium dantrolene was administered. After the improvement of NMS, colostomy was done. Dehydration and malnutrition of the patient were severe at the time of operation, and the possibility of NMS developing due to stress was thought to be very high. We administered sodium dantrolene to prevent NMS after the operation, and the management for prevention of NMS is discussed.

[Anesthetic management of the cesarean section in a patient with aplastic anemia]

A 31-year-old woman with aplastic anemia was admitted for the management of delivery at 33 weeks of gestation. Platelet count was 2.3 x 10(4) x microl(-1) on admission. Corticosteroid therapy after admission was not effective, and we decided to manage the delivery with elective cesarean section after platelet transfusion. After forty units of platelet transfusion, platelet count was 8.1 x 10(4) x microl(-1), and we decided to perform cesarean section under spinal anesthesia. Spinal anesthesia was given using a 25-gauge Quincke needle at L3-4 interspace, and 0.5% hyperbaric bupivacaine 2.5 ml with 0.15 mg morphine was injected. Block level was confirmed as T8 by a pinprick method. Blood loss during operation was 858 g, and complications were not seen during operation. In the case of delivery with uncontrolled aplastic anemia, elective cesarean section is thought to be safe. If platelet count is over 5.0 x 10(4) x microl(-1) after platelet transfusion, spinal anesthesia should be used.

[Anesthetic management of a patient with an ultra huge ovarian tumor]

We managed a patient with an ultra huge ovarian tumor weighing 48 kg. The patient was a 45-year-old woman and could not keep the supine position because of the respiratory disorder. Under local anesthesia with sedation, 28,000 ml of fluid was suctioned from the ultra huge ovarian tumor within about 2 hours in the left lateral position. The patient was turned into the supine position, and general anesthesia was induced. During the surgery, temporary oxygen desaturation and slight hypotension were observed after rapid suction from the ovarian tumor, but hemodynamic condition was almost stable. After extubation, respiratory and hemodynamic condition was good, and the patient had no postoperative complications. Anesthetic management of an ultra huge ovarian tumor is discussed.

Factor XI contributes to thrombus propagation on injured neointima of the rabbit iliac artery

BACKGROUND

Thrombus formation through the activation of tissue factor (TF) and factor (F) XI is a critical event in the onset of cardiovascular disease. TF expressed in atherosclerotic plaques and circulating blood is an important determinant of thrombogenicity that contributes to fibrin-rich thrombus formation after plaque disruption. However, the contribution of FXI to thrombus formation on disrupted plaques remains unclear.

METHODS

A mouse monoclonal antibody against FXI and activated FXI (FXIa) (XI-5108) was generated by immunization with activated human FXI. Prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time, and ex vivo platelet aggregation in rabbits were measured before and after an intravenous bolus injection of XI-5108. We investigated the role of FXI upon arterial thrombus growth in the rabbit iliac artery in the presence of repeated balloon injury.

RESULTS

The XI-5108 antibody reacted to the light chain of human and rabbit FXI/FXIa, and inhibited FXIa-initiated FXa and FXIa generation. Fibrin-rich thrombi developed on the injured neointima that was obviously immunopositive for glycoprotein IIb-IIIa, fibrin, TF, and FXI. Intravenous administration of XI-5108 (3.0 mg kg(-1)) remarkably reduced thrombus growth, and the APTT was significantly prolonged. However, PT, bleeding time and platelet aggregation were not affected.

CONCLUSIONS

These results indicate that plasma FXI plays a potent role in thrombus growth on the injured neointima. Inhibition of plasma FXI activity might help to reduce thrombus growth on ruptured plaques without prolonging bleeding time.

Potential impact of global warming on deciduous oak dieback caused by ambrosia fungus Raffaelea sp. carried by ambrosia beetle Platypus quercivorus (Coleoptera: Platypodidae) in Japan

Deciduous oak dieback in Japan has been known since the 1930s, but in the last ten years epidemics have intensified and spread to the island's western coastal areas. The symbiotic ambrosia fungus Raffaelea sp. is the causal agent of oak dieback, and is vectored by Platypus quercivorus (Murayama). This is the first example of an ambrosia beetle fungus that kills vigorous trees. Mortality of Quercus crispula was approximately 40% but much lower for associated species of Fagaceae, even though each species had a similar number of beetle attacks. It is likely that other oaks resistant to the fungus evolved under a stable relationship between the tree, fungus and beetle during a long evolutionary process. Quercus crispula was probably not part of this coevolution. This hypothesis was supported by the fact that P. quercivorus showed the least preference for Q. crispula yet exhibited highest reproductive success in this species. Therefore, P. quercivorus could spread more rapidly in stands with a high composition of Q. crispula. The present oak dieback epidemic in Japan probably resulted from the warmer climate that occurred from the late 1980s which made possible the fateful encounter of P. quercivorus with Q. cripsula by allowing the beetle to extend its distribution to more northerly latitudes and higher altitudes. Future global warming will possibly accelerate the overlapping of the distributions of P. quercivorus and Q. crispula with the result that oak dieback in Q. crispula will become more prevalent in Japan.

[Supraciliochoroidal fluid at an early stage after trabeculectomy]

PURPOSE

To examine the supraciliochoroidal fluid(SCF) by ultrasound biomicroscopy(UBM) at an early stage after trabeculectomy.

SUBJECTS AND METHODS

Fifteen eyes without post-operative complications were examined by UBM before the operation and less than 2 weeks after trabeculectomy with mitomycin C.

RESULTS

SCF was detected postoperatively in 6 eyes. One eye had choroidal detachment under indirect-ophthalmoscope and 5 eyes(33%) had SCF without choroidal detachment. The SCF in 4 eyes disappeared within 4 weeks after trabeculectomy. The intraocular pressure was 6.4 +/- 3.4 mmHg(mean +/- standard deviation) when SCF was detected and it rose to 13.2 +/- 7.2 mmHg when SCF disappeared. The intraocular pressure was 11.4 +/- 4.0 mmHg in the eyes without SCF, which was significantly higher than in the eyes with SCF.

CONCLUSION

At an early stage after trabeculectomy, SCF was detected by UBM in some cases without ophthalmoscopic choroidal detachment. Compared with the reported frequency of SCF after 3 or 6 months, our study revealed that SCF was present more frequently at an early stage after trabeculectomy. Our results may indicate that the presence of SCF is related to early low intraocular pressure and that disappearance of SCF induces the elevation of intraocular pressure.

Sugar-pendant diamines

A set of 1,3-propanediamine derivatives connected to carbohydrates (5) has been prepared in four steps from peracetylated sugar and 1,3-dibromo-2-propanol in 60-73% yields. D-Glucose, D-mannose, D-galactose, D-xylose, D-ribose, and maltose are utilized as sugar molecules in this work. The diamine moiety was connected to the C1 carbon of the glycopyranose ring via an O-glycoside bond. All of the anomeric configurations and sugar puckering conformations, except in the D-maltose derivative, were determined by X-ray crystallography of the diazido or dibromo precursors. While glycosidation of peracetylated galactopyranose with 1,3-dibromo-2-propanol in the presence of boron trifluoride afforded both anomers, the neighboring group participation of the 2-acetoxy group yielded a single anomer for the other substrates. This method has been used to synthesize a library of sugar-pendant diamines including an OH-protected derivative (6), and an N,N'-diisopropyl-substituted derivative (7). A similar series of reactions using 2,3-dibromo-1-propanol gave ethylenediamine-type derivatives (11), and bis(bromomethyl)bis(hydroxymethyl)methane (12) gave bisglucose-pendant derivatives (16).

[Anterior chamber structural change in postural variation in pseudoexfoliation syndrome]

PURPOSE

The anterior chamber structure in the supine position and the prone position was investigated with ultrasound biomicroscopy (UBM) in pseudoexfoliation syndrome (PE).

METHODS

We studied 12 eyes of 12 PE subjects. Patients were placed in the supine position for 30 minutes, after which UBM was performed. The UBM was repeated after 30 minutes in the prone position. Anterior chamber depth (ACD), angle opening distance 500 microns (AOD 500), and angle recess area (ARA) in 4 quadrants were measured.

RESULTS

Following the postural change from the supine position to the prone position, ACD decreased significantly (p < 0.0001). AOD 500 and ARA decreased significantly in the superior (AOD 500: p < 0.05, ARA: p = 0.03) and temporal quadrants (AOD 500: p < 0.0001, ARA: p < 0.0001).

CONCLUSIONS

The anterior chamber structural change was greater in the temporal and superior quadrants in the PE eyes. This corresponds with previous reports that zonular involvement by pseudoexfoliation material is more pronounced temporally and superiorly.

Anxiety and pain suppress the natural killer cell activity in oral surgery outpatients

OBJECTIVE

Psychological stress has an influence on natural killer cell (NK) activity, which plays a central role in protection against microbial infection and cancer. Anxiety concerning cancer is a typical type of psychological stress observed in patients and is associated with various diseases. In this study, we examined whether anxiety about cancer reduces the NK activity or quality of life (QOL), or both, of outpatients.

PATIENTS AND METHODS

NK activity was determined by means of a 4-hour 51 chromium-release assay, and a QOL questionnaire by the World Health Organization called QOL-BRIEF was also used. One hundred forty-four patients were asked a variety of questions about anxiety with respect to cancer and pain on their first visit to the outpatient clinic of our Department of Oral Surgery.

RESULTS

The NK activity in patients with anxiety about cancer was significantly lower (P < .001) than that in those with no such anxiety. In contrast, NK activity was not influenced by any other factor tested, including differences in diseases and QOL scores.

CONCLUSION

Anxiety about cancer may be one of the primary factors for suppression of NK activity in oral surgery outpatients.

Iris and ciliary body melanomas: ultrasound biomicroscopy with histopathologic correlation

OBJECTIVE

To correlate ultrasound biomicroscopic images of iris and ciliary body melanomas with their histopathologic features.

METHODS

Ultrasound biomicroscopy was performed in 3 cases of iris melanoma and in 3 cases of ciliary body melanoma. Cross-sectional ultrasound biomicroscopic images were compared with findings from clinical examination and light microscopy to evaluate associations between their histopathologic, surface, and internal ultrasound characteristics. Unique images of intrastomal and obscured posterior tumor margins were visualized by ultrasound biomicroscopy.

RESULTS

Results of this study revealed that ultrasound biomicroscopy offers an accurate method to evaluate tumor shape, reflectivity, and local invasion. Neoplastic tissue had only medium echogenicity. Enlarged vessels were correlated to echolucent spaces in the iris stroma. Anterior tumor margins were found within the iris stroma, within the anterior chamber angle, and on the endothelial surface of the cornea. Posterior tumor extension was noted to encroach onto the lens, into the sclera, and serous peripheral retinal detachments were associated with ciliary body tumors.

CONCLUSION

Ultrasound biomicroscopic images correlated well with histopathologic features of anterior uveal melanomas including shape, reflectivity, and local extension. Arch Ophthalmol. 2000;118:1515-1521

Effects of epinephrine and lactate on the increase in oxygen consumption of nonexercising skeletal muscle after aerobic exercise

The purpose of this study was to measure O2 consumption of nonexercising skeletal muscles (VO2nonex) at rest and after aerobic exercise and to investigate the stimulant factors of O2 consumption. In experiment 1, we measured the resting metabolic rate of the finger flexor muscles in seven healthy males by 31P-magnetic resonance spectroscopy during a 15 min arterial occlusion. In experiment 2, the VO2nonex of the finger flexor muscles was measured using near infrared continuous wave spectroscopy at rest, immediate postexercise, and 3, 5, 10, 15, and 20 min following a cycling exercise at a workload corresponding to 50% of peak pulmonary O2 uptake for 20 min. We also monitored deep tissue temperature in the VO2nonex measurement area and determined catecholamines and lactate concentrations in the blood at rest and immediate postexercise. VO2nonex at rest was 1.1 +/- 0.1 microM O2/S (mean +/- standard error) and VO2nonex after exercise increased 59.6 +/- 7.2% (p < 0.001) from the resting values. There were significant correlations between the increase in VO2nonex and the increase in epinephrine concentration (p < 0.01), and between the increase in VO2nonex and the increase in lactate concentration (p < 0.05). These results suggest that epinephrine and lactate concentrations are important VO2nonex stimulant factors.

A technique for performing ultrasound biomicroscopy in the sitting and prone positions

To develop a reliable method for performing ultrasound biomicroscopy (UBM) in the sitting and prone positions. The probe suspended from an articulated arm was removed and reattached to the arm upside-down for use in the prone position and horizontally for use in the sitting position. A latex Tono-Pen tip cover was attached to the edge of the eyecup and was placed over the transducer through the small hole on the tip of the Tono-Pen tip cover. UBM was successfully performed in the prone and sitting positions with no loss of image quality. This method can expand the ability of the UBM to examine alterations in anatomic relationships among anterior segment structures between the supine, sitting, and prone positions.

Angle recess area decreases with age in normal Japanese

PURPOSE

To investigate prospectively the relationships between anterior chamber angle configuration and refractive error, axial length, age, and body height in the Japanese.

METHODS

We studied 65 eyes of 65 subjects (30 men, 35 women) who were either patients at the Ophthalmology Department of Mie University or volunteers. The 65 subjects underwent a complete eye examination, A-scan biometry, and ultrasound biomicroscopy. Images were exported to an IBM-compatible personal computer in PCX format. The angle recess area (ARA) was measured using a software program of our own design.

RESULTS

The ARA decreased with age in all quadrants of all eyes. In older individuals, the angle in the superior quadrant was significantly narrower than in the other quadrants. The ARA correlated directly with anterior chamber depth (P < .001), axial length (P < .001), and body height (P = .003), and inversely with age (P < .001) and refractive error (P = .003) in pairwise analysis. Multivariate analysis revealed a significant association between ARA and anterior chamber depth (P < .001), axial length (P = .016), and younger age (P = .043).

CONCLUSIONS

The anterior chamber area narrows with age, especially in the superior quadrant. Narrowing of the angle in Japanese is associated with older age, shorter axial length, and shallower anterior chamber depth. We hypothesize that because of the increasing prevalence of axial myopia in younger Japanese, angle-closure glaucoma could become less common in Japan in the future.

Differential diagnosis of anterior segment cysts by ultrasound biomicroscopy

BACKGROUND

To describe the ultrasound biomicroscopic (UBM) features of anterior segment cysts.

DESIGN

A retrospective case series.

PARTICIPANTS

One hundred eighteen eyes with anterior segment cysts examined by UBM at The New York Eye and Ear Infirmary between August 1992 and November 1997 were included in this study.

INTERVENTION

The authors reviewed demographic and diagnostic data from the medical record including ocular and medical history, age, race, gender, and intraocular pressure. Ultrasound data concerning the type, number, position, and acoustic characteristics of cysts were recorded. The authors then correlated the written, clinical, and UBM characteristics.

RESULTS

One hundred eyes (92.6%) had neuroepithelial cysts. Ninety (83.3%) of these had primary neuroepithelial cysts, 10 (9.3%) had cysts associated with uveitis, 7 (6.5%) had implantation cysts, and 1 (0.9%) had a cavitated ciliary body tumor. Neuroepithelial cysts typically were round or ovoid, thin-walled, and echolucent. Of the 90 eyes with primary neuroepithelial cysts, 56 (62.2%) had 3 or fewer cysts; multiple cysts (>3 per eye) were found in 34 eyes (37.8%). The multiple cysts occupied more than 180 degrees in 12 patients (13.3%). Primary neuroepithelial cysts were located at the iridociliary junction (74.2%), pars plicata (14.0%), pars plana (6.8%), and iris (5.0%). Implantation cysts (seven eyes) tended to have thicker walls and two contained a copious, echogenic material.

CONCLUSION

The UBM results provide important information regarding location and extent of anterior segment cystic lesions. Ultrasound characteristics may help differentiate between neuroepithelial, implantation, and neoplastic cysts.

Ultrasound biomicroscopy dark room provocative testing: a quantitative method for estimating anterior chamber angle width

PURPOSE

To describe a quantitative method for measuring the iridocorneal angle recess area, and, using this, to evaluate factors associated with appositional angle-closure during dark room provocative testing using ultrasound biomicroscopy (UBM).

METHODS

All patients (178 patients, 178 eyes) with clinically narrow angles referred for UBM dark room provocative testing between September 1996 and March 1998 were enrolled in this study. Images of the inferior quadrant of the angle taken under standardized dark and light conditions were analyzed. The angle recess area (ARA) was defined as the triangular area demarcated by the anterior iris surface, corneal endothelium, and a line perpendicular to the corneal endothelium drawn from a point 750 microm anterior to the scleral spur to the iris surface. ARA, and acceleration and gamma-intercept of the linear regression analysis of the ARA were calculated. In the linear regression formula, y = ax + b, the acceleration a describes the rate at which the angle widens from the scleral spur; the y-intercept b describes the distance from the scleral spur to the iris.

RESULTS

Under dark conditions, the angles in 99 patients (55.6%) showed evidence of appositional angle-closure during testing. ARA (0.11 +/- 0.04 vs. 0.15 +/- 0.05 mm2, P < .0001, Student t-test), acceleration a (0.22 +/- 0.15 vs. 0.26 +/- 0.17, P = .068), and y-intercept b (66 +/- 46 vs. 92 +/- 47 microm, P = .0003) were smaller in eyes that were occluded. In the eyes that were not occluded, y-intercept b showed no significant difference between light and dark conditions (P = .1, paired t-test), while acceleration a did (P < .0001). In the eyes that were occluded, both decreased significantly under dark conditions (P < .0001). CONCLUSIONS The ARA linear regression formula provides useful quantitative information about angle recess anatomy. The more posterior the iris insertion on the ciliary face, the less likely the provocative test will be positive.

A slit-lamp needling filtration procedure for uncontrolled glaucoma in pseudophakic and aphakic eyes

In one aphakic and one pseudophakic patient without previous filtration surgery, a transconjunctival needling procedure similar to that used for failed filtration procedures was performed to create a filtering bleb. In both cases, intraocular pressure was successfully lowered for 6 months until the occurrence of bleb encapsulation, which was relieved by transconjunctival needling. There were no complications. In selected cases, this minimally invasive slit-lamp needling procedure provides successful filtration.

Iridolenticular contact decreases following laser iridotomy for pigment dispersion syndrome

OBJECTIVE

To evaluate changes in anterior segment anatomy after laser iridotomy for pigment dispersion syndrome.

METHODS

Ultrasound biomicroscopy was performed on 7 eyes of 7 untreated patients with reverse pupillary block and pigment dispersion syndrome. A radially oriented image with the probe perpendicular to the eye in the superior meridian was obtained before and at least 1 week after laser iridotomy in each eye. We assessed changes in angle recess area and iris-lens contact distance.

RESULTS

Mean +/- SD patient age was 31.3 +/- 5.7 years and mean +/- SD refractive error was -5.0 +/- 3.9 diopters. Angle recess area (mean +/- SD, 0.78 +/- 0.28 vs 0.35 +/- 0.11 mm2; P=.001, paired t test) and iris-lens contact distance (2.05 +/- 0.28 vs 0.79 +/- 0.13 mm; P<.001) decreased following iridotomy. Central anterior chamber depth did not change.

CONCLUSION

Flattening of the iris following laser iridotomy for pigment dispersion syndrome causes a decrease in iris-lens contact and angle width while lens position remains constant.

Reduced blood flow in abdominal viscera measured by Doppler ultrasound during one-legged knee extension

The redistribution of blood flow (BF) in the abdominal viscera during right-legged knee extension-flexion exercise at very low intensity [peak heart rate (HR), 76 beats/min] was examined by using Doppler ultrasound. While sitting, subjects performed a right-legged knee extension-flexion exercise every 6 s for 20 min. BF was measured in the upper abdominal aorta (Ao), right common femoral artery (RCFA), and left common femoral artery (LCFA). Visceral BF (BFVis) was determined by the equation [BFAo - (BFRCFA + BFLCFA)]. A comparison with the change in BF (DeltaBF) preexercise showed a greater increase in DeltaBFRCFA than in DeltaBFAo during exercise. This resulted in a reduction of BFVis to 56% of its preexercise value or a decrease in flow by 1,147 +/- 293 (+/-SE) ml/min at the peak workload. Oxygen consumption correlated positively with DeltaBFAo, DeltaBFRCFA, and DeltaBFLCFA but inversely with DeltaBFVis during exercise and recovery. Furthermore, BFVis (% of preexercise value) correlated inversely with both an increase in HR (r = -0.89), and percent peak oxygen consumption (r = -0.99). This study demonstrated that, even during very-low-intensity exercise (HR <90 beats/min), there was a significant shift in BF from the viscera to the exercising muscles.

Anterior segment implantation cysts. Ultrasound biomicroscopy with histopathologic correlation

OBJECTIVE

To correlate the clinical, histopathologic, and ultrasound biomicroscopic characteristics of anterior segment implantation cysts.

METHODS

We performed a retrospective review of 7 cases of secondary anterior segment implantation cysts. We reviewed the clinical history, visual acuity, clinical findings, and ultrasound biomicroscopic characteristics in all cases. Histopathologic correlation was possible in 4 cases.

RESULTS

Six eyes had been subjected to major trauma prior to cyst formation. Trauma was noted as blunt in 3 eyes and surgical in 3 eyes. The diagnosis was confirmed in 1 eye when conjunctival cells were aspirated on fine needle biopsy. Ultrasound biomicroscopy revealed large (mean +/- SD greatest diameter, 4.7 +/- 0.9 mm) cystic tumors. In 1 patient, a cyst-related indentation of the anterior lens surface was seen. Ultrasonographic evaluations of internal reflectivity revealed thick, moderately reflective cyst walls encapsulating a relatively hypoechoic core. In 3 cases, the cyst contents consisted of variably reflective material. The other 4 were completely sonolucent. Histopathologic correlation showed that the cyst walls were lined with stratified squamous epithelium. The moderately reflective cyst contents were found to be degenerated conjunctival cells with inflammatory foci and cholesterol crystals. The sonolucent regions correlated with inflammatory cells and fluid.

CONCLUSIONS

This study demonstrates that implantation cysts are unilateral, large, and thick walled. They may be sonolucent or exhibit variable internal reflectivity. These findings as well as the extent of anterior segment involvement (particularly posterior extension) could be evaluated by ultrasound biomicroscopy prior to surgery.

Identification of tumor vascular antigens by monoclonal antibodies prepared from rat-tumor-derived endothelial cells

We have reported the isolation and specific in vitro properties of tumor-derived endothelial cells (TEC) from rat KMT-17 fibrosarcomas transplanted into rats. To develop antibody-based tumor vascular targeting therapy for solid tumors, we have generated monoclonal antibodies (MAbs) using passive immunization of outside-out membrane vesicles of rat epididymal-fat-pad-derived capillary endothelial cells (FCEC) followed by active immunization of those of rat TEC. The MAbs produced were screened against TEC and FCEC. Of all cultured hybridomas, 75 (3.3%) of the secreted MAbs preferentially recognized TEC. We selected a total of 7 MAbs which detected antigens highly abundant in TEC, although 5 of the 7 MAbs were weakly positive for FCEC in cell-ELISA and FACS analyses. The antigens recognized by these MAbs, with the exception of MAb TES-7, were present on endothelial cells of tumor blood vessels in KMT-17 fibrosarcoma tissues, as shown by immunohistochemical analysis. Antigens of 40- and 80-kDa were recognized by MAbs TES-1, 7, 17, 21 and 26 and by MAbs TES-23 and 27 respectively. Although the function of these antigens, which are preferentially expressed on rat tumor-derived endothelial cells, is still unknown, we believe that future studies of such antigens will help elucidate the role of endothelial cells in tumor vasculature. Our results indicate that MAbs may provide a novel tool for the development of antibody-based therapy targeting tumor vasculature.

Identification of tumor vascular antigens by monoclonal antibodies prepared from rat-tumor-derived endothelial cells

We have reported the isolation and specific in vitro properties of tumor-derived endothelial cells (TEC) from rat KMT-17 fibrosarcomas transplanted into rats. To develop antibody-based tumor vascular targeting therapy for solid tumors, we have generated monoclonal antibodies (MAbs) using passive immunization of outside-out membrane vesicles of rat epididymal-fat-pad-derived capillary endothelial cells (FCEC) followed by active immunization of those of rat TEC. The MAbs produced were screened against TEC and FCEC. Of all cultured hybridomas, 75 (3.3%) of the secreted MAbs preferentially recognized TEC. We selected a total of 7 MAbs which detected antigens highly abundant in TEC, although 5 of the 7 MAbs were weakly positive for FCEC in cell-ELISA and FACS analyses. The antigens recognized by these MAbs, with the exception of MAb TES-7, were present on endothelial cells of tumor blood vessels in KMT-17 fibrosarcoma tissues, as shown by immunohistochemical analysis. Antigens of 40- and 80-kDa were recognized by MAbs TES-1, 7, 17, 21 and 26 and by MAbs TES-23 and 27 respectively. Although the function of these antigens, which are preferentially expressed on rat tumor-derived endothelial cells, is still unknown, we believe that future studies of such antigens will help elucidate the role of endothelial cells in tumor vasculature. Our results indicate that MAbs may provide a novel tool for the development of antibody-based therapy targeting tumor vasculature.

Putative tumor suppressor gene region within 0.85 cM on chromosome 12 in radiation-induced murine lymphomas

Analyses of genetic alterations in tumors from F1 hybrid mice produced by inter-subspecific crosses between genetically well-characterized inbred strains provide precise and comprehensive evidence for genetic abnormalities such as allelic loss. We performed loss of heterozygosity (LOH) analyses of 125 radiation-induced lymphomas of (BALB/cHeA x MSM/Ms)F1 hybrid mice by polymerase chain reaction (PCR) analysis of microsatellite DNA polymorphic markers. Very frequent LOH was found at a distal region on chromosome 12. To precisely define the most common region of LOH, we first determined the order of and distances between the available microsatellite loci around the region by using 586 (CXSD x MSM/Ms)F2 hybrid mice (1172 meiosis). The locus order and distances were [centromere]-D12Mit132-(0.34 cM)-D12Mit5O-(2.05 cM)-[D12Mit122, D12Mit53]-(0.85 cM)-D12Mit233-(0.43 cM)-D12Mit279-(O.17 cM)-D12Mit181-[telomere]. We then investigated the features of LOH at these loci. The highest frequency of LOH (83 of 125, 66%) was found at D12Mit233. The LOH patterns of individual lymphomas indicated that the most common region of LOH was within the 0.85 cM between D12Mit53 and D12Mit233, a region homologous to human chromosome 14q32.1. These results suggest that a putative novel tumor suppressor gene exists within this region.

[Clinical evaluation of chemiluminescence immunoassay PSA (ACS-PSA) for detection of prostate cancer]

Serum prostate specific antigen (PSA) levels were measured using an ACS-PSA kit in 147 systematic biopsy cases (61 with prostate cancer (PC)) and 96 transurethral resection of prostate (TUR-P) cases (2 with PC). In the 147 biopsy cases, the sensitivity for PSA using 3.0 and 10.0 ng/ml as cut-off values was 91.8 and 90.2%, while the specificity was 9.30 and 30.2%, respectively. The sensitivity for PSAD (A) (calculated by transabdominal ultrasound) using 0.25 and 0.5 ng/ml/cm3 as cut-off values was 91.8 and 90.2%, while the specificity was 22.1 and 50.0%, respectively. These data indicated that PSAD (A) provided better information for detecting PC than PSA alone. No statistical difference was found between PSAD (A) and PSAD (R) (calculated by transrectal ultrasound) in the utility of detecting PC. PSA below 15.0 ng/ml was seen in sixteen patients with PC. Five of these sixteen patients had a PSA level of < 3.0, and they underwent prostate biopsy based on the abnormality by digital rectal examination (DRE). The other eleven patients had PSAD (A) level of > 0.3 ng/ml/cm3. In all 243 cases, PC was not found in the 49 patients (PSA < 3.0 ng/ml) or 91 patients (PSAD (A) < 0.25 ng/ml/cm3) who had no abnormal findings by DRE and transabdominal ultrasonography. These results suggested a criterion in the use of the ACS-PSA kit for the indication of prostate biopsy and TUR-P.

Treatment of sleep apnea with a new separated type of dental appliance (mandibular advancing positioner)

We investigated a new separated type of dental appliance (mandibular advancing positioner: MAP) that is mobile and allows free adjustment of mandibular advancement. In 8 adult male patients with sleep apnea syndrome (SAS), the mean apnea index (AI) decreased from 31.1 to 4.2, and the mean apnea hypopnea index (AHI) decreased from 44.2 to 11.7. The distance of mandibular advancement using the Flankfort horizontal plane as a standard ranged in the 8 SAS patients from 1.8 to 5.0 mm by lateral cephalograms. A high positive correlation was observed between the distance of mandibular advancement and the rate of improvement in AI (R2 = 0.878), or the rate of AHI (R2 = 0.861), showing a higher improvement rate with more marked mandibular advancement.

Effect of tacrolimus hydrate (FK506) ointment on spontaneous dermatitis in NC/Nga mice

The effect of tacrolimus hydrate (FK506) ointment on spontaneous dermatitis in NC/Nga (NC) mice was examined. FK506 ointment (0.1-1%) suppressed the development of dermatitis and was also therapeutically effective against established dermatitis. Increases in CD4-positive T cells (helper T cells), mast cells, eosinophils and immunostaining of interleukin (IL)-4, IL-5 and IgE were confirmed in the skin of the NC mice, and FK506 ointment suppressed all of these changes. Increased plasma IgE was also confirmed in the NC mice, and treatment with FK506 ointment reduced the plasma IgE level. These results suggested that FK506 suppressed the dermatitis by inhibiting the activation of inflammatory cells and by blocking the cytokine network in the skin of the NC mice. The commercially available steroid ointments showed only marginal effect on the development of dermatitis and showed some signs of side effects such as alopecia or atrophy of the skin. The effect of the steroids might have been masked by these side effects because the steroids showed similar inhibitory effects on the skin histopathological changes and the increase of plasma IgE. From these results, FK506 ointment can be expected to be a useful drug for atopic dermatitis.

Mapping of new recessive cataract gene (lr2) in the mouse

A new strain of mice with cataracts was developed in BALB/cHeA and STS/A recombinant inbred strain, CXS4 (D). In this study the mapping of spontaneous autosomal recessive cataract mutation is described. This mutation was characterized by ruptures of the lens nucleus, vitreous chamber through the posterior capsule, and the vacuolization of the lens. For the linkage analysis, we produced two kinds of backcross progenies, (BALB/cHeA x D)F1 and (STS/A x D)F1 females crossed to D male mice. The gene (lr2, lens rupture2) was mapped to the central part of Chromosome(Chr) 14, 0.7 +/- 0.7 cM from the micosatellite marker D14Mit28.

Antibody-based therapy targeting tumor vascular endothelial cells suppresses solid tumor growth in rats

We have developed a new approach to antibody-based therapy of solid tumors by targeting tumor vascular endothelial cells (EC) which are essential for the growth of solid tumors. We investigated the effect of an antibody against tumor-derived endothelial cells (TEC) on the growth of solid tumors in rats. Intravenous administration of TES-23, a monoclonal antibody generated by TEC isolated from rat KMT-17 solid tumors, at 1 mg/rat/day for 5 days resulted in significant suppression of KMT-17 tumor growth. Histopathological analysis of tumors administered with TES-23 showed that adhesion of lymphocytes to EC followed by denudation of EC in the viable tumor area. In contrast, little obvious toxicity was observed in most of the rat organs examined. These findings suggest that the concept of an antibody-based therapy with targeting tumor vascular EC would be promising in treatment of solid tumors.

A new hereditary cataract mouse with lens rupture

A new cataract model originated in a recombinant inbred (RI) strain, CXS4 or CXSD (D), between BALB/cHeA(BALB/c or C) and STS/A(STS or S) mice. Opacity appeared as a white pinpoint focus in unpigmented eyes of albino mice from 5 weeks old. All the mice were bilaterally affected by 14 weeks old. They were fully viable and fertile. There was no sex difference in incidence of cataract. Histologically, the 3-4 months old mice showed vacuoles in the lens cortex. The vacuoles were spread all over the lens cortex in advanced cases. Ruptures of the lens nucleus to the vitreous chamber was a typical occurrence. For elucidation of the mode of inheritance, F1 hybrids (CXD and SXD) and backcross progenies [(CXD)F1XD and (SXD)F1XD] were analysed. No affected mice were observed in F1 hybrids. In backcross progenies, the segregation ratio of affected and normal mice was close to 1:1 in both matings. We conclude that the cataract is inherited by an autosomal single recessive gene. This mutant gene is provisionally named 'lens rupture 2' (gene symbol 1r2, Mouse Genome Database Accession No. MGD-JNUM-37399). The new cataract model mouse will be a good tool for the genetic analysis and molecular biological study of cataractogenesis.

Genetic dissection of susceptibility to radiation-induced apoptosis of thymocytes and mapping of Rapop1, a novel susceptibility gene

Genetic dissection of susceptibility to radiation-induced apoptosis of thymocytes was performed by counting dead cells in histologically processed thymuses after 0.5 Gy of whole-body X-irradiation, using recombinant congenic (CcS/Dem) strains derived from inbred mouse strains BALB/cHeA (susceptible) and STS/A (resistant). A high (8/20) number of strains with lower dead cell scores than BALB/cHeA among CcS/Dem recombinant congenic strains (RCS), which contain 12.5% of STS/A genome in the genetic background of BALB/cHeA strain, indicates that the difference between BALB/cHeA and STS/A is caused by several genes and that susceptibility probably requires BALB/cHeA alleles at more than one locus. Similar results were obtained with CXS/Hg recombinant inbred (CXS/Hg) strains. Analysis of F2 hybrids between BALB/cHeA and CcS-7, one of the CcS/Dem strains that showed lower dead cell scores than BALB/cHeA, demonstrated that a novel gene (Rapop1, radiation-induced apoptosis 1) controlling susceptibility to radiation-induced apoptosis in the thymus is located in the proximal region of mouse chromosome 16.

Morphological analysis by lateral cephalography of sleep apnea syndrome in 53 patients

To determine the morphologic characteristics of patients with sleep apnea syndrome (SAS), the facial skeleton, tongue area, soft palate area and upper airway area were examined on lateral cephalograms from 53 male patients with SAS. The SAS patients were divided into two groups according to their body mass index (BMI): Group N (BMI < 25, N = 23) and Group O (BMI > or = 25, N = 30). Fifty non-snoring adult men were used as a control (Group C). The mean BMI of all 53 patients with SAS was 26.2 +/- 3.1 kg/m2. The mean SNB was smaller in Group N (76.7 +/- 3.2 degrees) than in Group C (78.4 +/- 3.0 degrees). The mean airway area was markedly smaller in Groups N and O than in Group C. The tongue area was larger in Groups N (36.0 +/- 2.3 cm2) and O (39.3 +/- 2.7 cm2) than in Group C (33.3 +/- 3.4 cm2). There was a positive correlation (R2 = 0.670) in all subjects between tongue area and body weight. There was also a positive correlation (R2 = 0.656) between tongue area and the distance between the ANS and the base of the epiglottis in the 103 subjects, the base of the epiglottis being shifted to a posteroinferior position as a result of the enlarged tongue. The findings suggest that micrognathia is a morphological characteristic of the Japanese patients with SAS. Micrognathia and enlargement of the tongue and soft palate due to obesity, were considered to be involved in the narrowing of the airway in SAS patients.

Radiation-induced lymphomas in MSM, (BALB/cHeA x MSM) F1 and (BALB/cHeA x STS/A) F1 hybrid mice

M.MOL-MSM (MSM) mice derived from Mus musculus molossinus progenitors showed extreme resistance to the induction of lymphomas following whole-body X-irradiation with four doses of 1.7 Gy. (BALB/cHeA x MSM) F1 mice between a high lymphoma strain, BALB/cHeA and the MSM showed a high incidence of radiation-induced lymphomas which was quite similar to that in BALB/cHeA mice, but the latent period was prolonged in the hybrids. Susceptibility in incidence was dominant over resistance in these crosses. Incidences of (BALB/cHeA x MSM)F1 hybrids irradiated with four doses of 2.5 Gy X-rays were 77% in females and 88% in males. F1 hybrids between BALB/cHeA and another resistant strain STS/A, (BALB/cHeA x STS/A) F1, also showed a high level of susceptibility, that is, lymphoma incidence was 64% in females and 63% in males. The mean latent period in the (BALB/cHeA x STS/A) F1 hybrids was similar to that in (BALB/cHeA x MSM) F1 hybrids. As all cases of tumors developed in F1 hybrids are informative concerning the detection of the loss of heterozygosity in the loci depending on the combination of two parental strains, the radiation-induced lymphomas obtained from (BALB/cHeA x MSM) F1 and (BALB/cHeA x STS/A) F1 hybrids could be useful for fine analysis of the genetic alterations involved in lymphomagenesis.

Essential role of polyamines in restoration of DNA synthesis after UV radiation and expression of UV resistance in Cockayne syndrome cells

Activity of ornithine decarboxylase (ODC) in Cockayne syndrome (CS) cells which were characterized by a delay of the recovery of DNA synthesis after 254 nm ultraviolet light (UV) radiation was extremely inhibited by UV, followed by a progressive decrease of putrescine. When putrescine was added in the cultures, CS cells showed a rapid recovery in DNA synthesis and also an expression of UV-resistance as seen in normal cells. Thus, ODC induction system of CS cells is highly sensitive to UV. Considering current hot spots in DNA repair, our results probably reflect a defect of preferentially rapid repair in ODC gene of CS cells.

Genetic control of the radiosensitivity of lymphoid cells for antibody formation ability in mice

To analyze the genetic basis of the relationship between the radiosensitivity of the immune response and radiation lymphomagenesis, we examined the radiosensitivity of lymphoid cells for antibody formation in BALB/cHeA, STS/A, F1 hybrids, and their recombinant inbred mouse strains. The decrease in the number of plaque-forming spleen cells in BALB/cHeA mice exposed to 3 Gy X-irradiation was more than tenfold that in STS/A mice. The phenotype of radioresistance was dominant over sensitivity. The coincidence between the strain distribution patterns of the genetic markers and radiosensitivities of antibody formation in the various recombinant inbred strains was in the region with the Igh locus on chromosome 12. There was obvious difference between the patterns in the region containing the Ifa locus on chromosome 4 which has been shown to be related to the incidence of radiation-induced lymphomas. These results indicate that the region on chromosome 12 may contain major gene(s) related to radiosensitivity for antibody formation.

Factors related to resistance to hematopoietic death in mice

Mouse strain difference in the radiosensitivity to hematopoietic death is thought to be determined by several factors besides radiosensitivity and the initial number of hematopoietic stem cells. Factors related to the survival of mice exposed to X-irradiation were analyzed using BALB/cHeA and STS/A strains whose LD50/30 values differ markedly (BALB/cHeA, 5.55 Gy; STS/A, 8.45 Gy). STS/A mice exposed to 4 Gy of X-irradiation showed a small reduction but rapid recovery of blood cells (leukocytes, erythrocytes, and thrombocytes) when compared with BALB/cHeA mice. The survival of endogenous and exogenous CFU-S was much higher, by a magnitude of one log or more, in STS/A mice than those in BALB/cHeA mice; whereas the initial numbers of femoral CFU-S were similar for the two strains. The recovery of exogenous CFU-S was much more rapid in STS/A mice than it was in BALB/cHeA mice after 4 Gy of X-irradiation. Furthermore, spleen colonies produced by the transfusion of STS/A marrow cells into syngeneic recipients were significantly larger than those produced by BALB/cHeA marrow cells, regardless of whether the mice used for sources of marrow cells had been irradiated. But, there was no such difference when unirradiated marrow cells from the two strains were transfused into (BALB/cHeA X STS/A) F1 recipients. These results indicate the possible contribution of a host factor (s) that stimulates the growth of spleen colonies after radiation to the radioresistance of STS/A mice, in addition to the primary effect of higher number of survivals of endogenous and exogenous CFU-S in STS/A mice.

Polypeptide and carbohydrate structure of recombinant human interleukin-6 produced in Chinese hamster ovary cells

A glycosylated form of human interleukin 6 (hIL-6) has been produced in Chinese hamster ovary (CHO) cells transfected with a cDNA clone for human IL-6. Recombinant hIL-6 was purified from a culture supernatant of the transfected CHO cells, and used for structural characterization. The complete amino acid sequence, composed of 185 amino acid residues, was determined and is identical to that predicted from the cDNA sequence. However, a recombinant hIL-6 species lacking two amino acid residues (Ala-Pro) from the N-terminus was also found. Two disulfide bonds are formed, between Cys45 and Cys51 and between Cys74 and Cys84. Recombinant hIL-6 carries one O-linked carbohydrate chain, and Thr139 is fully O-glycosylated. A portion of recombinant hIL-6 protein carries one N-linked sialooligosaccharide chain, and the N-glycosylation occurs at Asn46. The structure of the N-linked sugar chains was estimated by a combination of sugar mapping and glycosidase digestion. The major structure of the N-linked sugar chain predicted was of a fucosylated biantennary or triantennary complex type. Fucosylated triantennary sugar chains with one or two N-acetyllactosaminyl repeats were also found. The structure of the O-linked sugar chain was determined by 500 mHz 1H-NMR to be NeuAc alpha 2-3Gal beta 1-3(NeuAc alpha 2-6) Gal-NAcol.

Effect of psoralen + ultraviolet-A on the chemotactic activity of polymorphonuclear neutrophils towards anaphylatoxin C5a des Arg

It was shown that psoralen + UV-A inhibits the chemotactic activity of polymorphonuclear neutrophils towards anaphylatoxin C5a des Arg. This reaction required oxygen and there is a high possibility that the active oxygen species was in a singlet state. Oxygen did not act directly on C5a des Arg, but rather produced oxidized psoralen which inhibited C5a des Arg activity. The effect was dependent on the concentration and types of psoralen and on the UV-A dose. Among the psoralens, the inhibitory effect of 4,5',8-trimethylpsoralen was the strongest, followed by 8-methoxypsoralen and 3-carbethoxypsoralen and finally 4,4',6-trimethylangelicin. Psoralen + UV-A failed to inhibit the chemotactic activity towards chemotactants other than anaphylatoxin C5a such as casein, the cultured filtrate of E. coli, platelet-activating factor, leukotriene B4, 5-hydroxy-6,8,11,14-eicosatetraenoic acid and 12-L-hydroxy-5,8,10,14-eicosatetraenoic acid.

Dotted white--a plumage color mutant in Japanese quail (Coturnix coturnix japonica)

A plumage color mutant, dotted white (DTW), of Japanese quail is described in this paper. The adult DTW mutant shows white plumage with a small colored spot on the head and/or back. The pigmented spots invariably appear on the dorsal region and never on the ventral region of the body. Some birds lack colored spots and show pure white plumage. The chick of the DTW mutant shows cream yellow plumules similar to those of the White Leghorn chick. Colored spots also exist as in adults, and its coloration is diluted light brown. The feathers on colored spots of the adult show diluted pigmentation as compared with wild-type feathers. In addition, the wheat-straw colored shaft streak is extremely narrow and the transversal bars are missing. The DTW mutant is thought to be genetically different from previously reported similar mutants, brown-splashed white, panda, and recessive white. Genetic analyses revealed that the DTW mutant plumage is controlled by an autosomal recessive gene. The gene symbol dtw is provisionally proposed, since there remains a possibility that the DTW character may be allelic to some of the similar mutant characters mentioned above.

Structural elucidation of the 8-methoxypsoralen oxidized product that inhibits the chemotactic activity of polymorphonuclear neutrophils toward anaphylatoxin C5a

The chemical structure of the 8-methoxypsoralen oxidized product that inhibits the chemotactic activity of anaphylatoxin C5a was determined to be 2,3-dihydro-2,9-dimethoxy-3-hydroxy-7-oxo-7H-furo[3,2-g] [1]benzopyran. Its minimal concentration required to obtain the maximum inhibition of C5a des Arg (1 x 10(-8) M) chemotactic activity is 2.5 x 10(-8) M. Bioactivity of this substance was maintained for 2 weeks, stored in a dark room at room temperature under aerobic conditions. There is a possibility that this substance may be useful in the treatment of immune complex diseases.

Stumpy limb--an embryonic lethal mutation in Japanese quail (Coturnix coturnix japonica)

An embryonic lethal mutant was found in Japanese quail and named "stumpy limb (SL)". All SL embryos died at pre-hatching stages, showing brachycephaly, a thickened neck, short upper and lower beaks, and short and thick extremities, while their body length was similar to that of the normal embryos. Observations on the skeleton revealed a globular skull, unusual curvature of the Processus palatinus maxillaris of the upper beak, and shortening and thickening of the appendicular bones. Some embryos showed a bending of the humerus, femur and/or tibiotarsus. Abnormality was more conspicuous in the leg bones than in the wing bones. No conspicuous differences were observed in the vertebrae between the SL and normal embryos. A genetic analysis suggested that the mutation is controlled by an autosomal recessive gene, for which the gene symbol sl was proposed.

[Veno-arterial ECLA (extracorporeal lung assist) for severe respiratory failure due to meconium aspiration]

A full term newborn female, 3262g, aspirated meconium at birth and began to suffer from severe hypoxia and acidosis due to progressing pneumonitis, pneumothorax and pneumomediastinum. She also had severe hypotension and anuria. Venoarterial ECLA with a Kolobow membrane lung via the right internal jugular vein and the right common carotid artery was initiated. Blood gas parameters and blood pressure improved, and urine output increased to normal. ECLA permitted a reduction in FIO2 and airway pressure of mechanical ventilation, as well as frequent lavage of the lung. As the physical condition improved, the bypass flow was gradually decreased from 200 ml.kg-1.min-1 at the start to 130 ml.kg-1.min-1 for maintenance, then to 25 ml.kg-1.min-1 at the end. Bleeding throughout the ECLA for 69 hours could be minimized by a meticulous control of the activated coagulation time with a minimum dose of heparin and the transfusion of fresh frozen and platelet rich plasma. After ECLA, the carotid artery was simply ligated, and mechanical ventilatory support was carried out for 5 days. Her condition improved and she left the hospital without any neurological sequelae. ECLA will become an effective means of life support for a baby with severe MAS irresponsive to conventional ventilatory support.

Congenital epulis--an electron microscopic observations of two cases

Two cases of congenital epulis occurring in the gingiva at the site where the lower deciduous incisors were to erupt are described. The first patient was a 7 day-old female infant. Her epulis was diagnosed, histopathologically, as a granular cell tumor. Electron microscopy revealed that the tumor cells were large with small eccentric nuclei. The cells were filled with granular structures. These granular substances varied in size and electron density. Case 2 involved a 37 day-old male infant. A histopathological diagnosis of fibromatosis was made. Electron micrographs showed a proliferation of cells which resembled fibroblasts. These cells varied in shape, including some with thin, long processes. Abundant reticular and collagen fibers were present in the stroma. In both cases, the postoperative course was uneventful without recurrence.

[A case of acute airway obstruction with sharp sawdust particles, successfully treated by extracorporeal lung assist]

A 17 year-old male accidentally fell into a loading shute filled with sharp particles of sawdust. He aspirated a large amount of sawdust and suffered from acute airway obstruction accompanied by barotrauma, probably due to severe cough and tissue damage from the needle sharp sawdust particles. Ordinary mechanical ventilation was not enough to keep normal gas exchange. To sustain life, a venovenous extracorporeal lung assist, ECLA, with two Kolobow membrane lungs was performed. Under ECLA, the sawdust particles were removed from the airway one by one with a bronchofiber scope taking almost 10 hours. Then the left lung lavage was performed with normal saline to remove finer sawdust. The patient survived these procedures and was weaned from ECLA after 36 hrs. His recovery was uneventful.