Veno-Right Ventricle Bypass as a Lung Support System during Pulmonary Surgery without Ventilation

A special lung support technique is required during carina! or tracheal surgery. Veno venous extracorporeal membrane oxygenation (ECMO) has become an accepted techinique for temporary lung support. Therefore, the purpose of our experiments was to evaluate the effect of veno venous ECMO (veno-right ventricle bypass) without ventilatory support. In five mongrel dogs, two venous drainage cannula were inserted into the superior vena cava through the right jugular vein and the inferior vena cava through the right femoral vein. In addition, a venous return cannula was inserted into the right ventricle (RV) through the right jugular vein. The veno-right ventricle (veno-RV) bypass system was composed of a centrifugal pump and membrane oxygenator; pump flow was maintained at 88 ± 14 ml/kg/min. Excellent hemodynamics and good oxygenation were obtained. On the basis of these results, we conclude that veno-RV bypass may be used as lung support during pulmonary surgery even though the native lung is not ventilated during the veno-RV bypass procedure.

Spectrophotometric determination of nitrate and nitrite in water and some fruit samples using column preconcentration

A sensitive analytical method for the simultaneous assay of nitrate and nitrite in water and some fruit samples is presented. The method is based on nitrite determination using the diazotization-coupling reaction by column preconcentration and on the reduction of nitrate to nitrite using the Cd-Cu reductor column. Nitrite is diazotized with sulfanilamide (SAM) in the pH range 2.0-5.0, sulfamethizole (SM) in pH 1.8-5.6 and sulfadimidine (SD) in pH 1.8-4.0 in a hydrochloric acid medium to form water-soluble colourless diazonium cations. These cations were coupled with sodium 1-naphthol-4-sulfonate (NS) in the pH range 9.0-12.0 for the SAM-NS system, pH 8.6-12.0 for the SM-NS system and pH 9.4-12.0 for the SD-NS system to be retained on naphthalene-tetradecyldimethylbenzylammonium (TDBA)-iodide (I) adsorbent packed in a column. The solid mass is dissolved out from the column with 5 ml of dimethylformamide (DMF) and the absorbance is measured by a spectrophotometer at 543 nm for SAM-NS, 537 nm for SM-NS and 530 nm for SD-NS. The calibration graph was linear over 30-600 ng NO(2)-N and 22-450 ng NO(3)-N in 15 ml of final aqueous solution (i.e. 2-40 ng NO(2)-N ml(-1) and 1.5-30 ng NO(3)-N ml(-1) in aqueous sample) for three systems. The detection limits were 1.4 ng NO(2)-N ml(-1) and 1.1 ng NO(3)-N ml(-1) for SAM-NS, 1.2 ng NO(2)-N ml(-1) and 0.89 ng NO(3)-N ml(-1) for SM-NS, 1.0 ng NO(2)-N ml(-1) and 0.75 ng NO(3)-N ml(-1) for SD-NS, respectively. The concentration factor is eight for SAM-NS and SM-NS, and 12 for SD-NS. Interferences from various foreign ions have been examined and the method was successfully applied to the determination of low levels of nitrate and nitrite in water and some fruit samples.

A feasibility study of novel plastic scintillation dosimetry with pulse-counting mode

The purpose of this study was to develop a novel scintillation dosimeter for in vivo dosimetry in Ir-192 brachytherapy via the pulse-counting mode. The new dosimeter was made from a plastic scintillator shaped into a hemisphere of diameter 1 mm and connected to the tip of a plastic optical fiber. The relationship between pulse counts and absorbed dose was derived based on the assumption that scintillation photons from the incident gamma ray are proportional to the absorbed dose. An equation for the conversion of pulse counts to water-equivalent dose was deduced wherein the pulse height spectrum from scintillation photons was assumed to be exponential. To confirm its accuracy, the dose rate distribution in a water phantom was measured by the present dosimeter and this was compared with Monte Carlo simulations, resulting in a discrepancy of less than 1.97%. It was found that the dosimeter has a wide dynamic range of linearity up to an order of magnitude of almost 10(3), including corrections for loss of counts due to pile-up.

Application of several types of substrates to ficin-catalyzed peptide synthesis

The capability of ficin, a cystine protease, to form peptide bonds was investigated using several types of N-Boc-amino acid phenyl and naphthyl esters as acyl donor components. Enzyme-catalyzed peptide synthesis was carried out under optimized reaction conditions of pH, acyl acceptor concentration and selection of the best yield organic solvent. It used a condensation of N-Boc-Ala-OpGu and Ala-pNA as a model reaction. The products were obtained in 72-96% yield using 10 different substrates, within a few minutes of reaction time.

Inflammatory pseudotumor of the breast in a patient with a high serum IgG4 level: histologic similarity to sclerosing pancreatitis

The association between IgG4 and inflammatory pseudotumor was first reported with regard to pancreatic pseudotumor, which is well known as sclerosing pancreatitis or autoimmune pancreatitis. In addition, there is increasing evidence that IgG4 is also involved in inflammatory pseudotumor of the extrapancreatic tissue. In this report, we present a case of IgG4-related inflammatory pseudotumor of the breast. A 46-year-old woman presented with an induration in the left breast. Radiologic examination revealed an ill-circumscribed mass measuring 1.6 cm in diameter in the left breast. Breast cancer could not be ruled out radiologically, and excision biopsy was performed for a definite diagnosis. Histologically, this nodule was composed of an irregular proliferation of stromal cells associated with severe lymphoplasmacytic infiltration, obliterative phlebitis, and eosinophils. No atypical feature regarding the stromal cells or lymphocytes was observed. Furthermore, many plasma cells within the lesion were immunohistochemically positive for IgG4, and the serum IgG4 concentration of this patient was elevated on postoperative examination. This case suggests that inflammatory pseudotumor of the breast has a pathogenetic process similar to that of sclerosing pancreatitis. IgG4 might become a useful marker for inflammatory pseudotumor of the breast, and it might benefit from steroid therapy, as does sclerosing pancreatitis.

Treatment of a patient with hemophilia A and hepatitis C virus-related cirrhosis by living-related liver transplantation from an obligate carrier donor

BACKGROUND

Decompensated hepatitis C virus (HCV)-related cirrhosis is the main indication for liver transplantation. We report the first successful living-related liver transplantation in a 49-year-old hemophilia A patient with end-stage HCV-related cirrhosis using a graft obtained from his 20-year-old daughter, an obligate carrier.

METHODS

The donor's autologous fresh-frozen plasma rich in factor VIII (FVIII) by treatment with 1-deamino-8-D-arginine vasopressin was prepared before the operation. At induction, 1-deamino-8-D-arginine vasopressin was given to the donor to increase plasma FVIII level. In addition, autologous fresh-frozen plasma containing high FVIII concentrate was infused intraoperatively. The right lobe was harvested from the donor and transplanted orthotopically. The recipient was treated postoperatively with recombinant FVIII and immunosuppressive agents.

RESULTS

The donor did not receive recombinant FVIII or allogenic blood during perioperative periods. No bleeding was encountered in the donor perioperatively. The recipient showed a steady increase in FVIII activity postoperatively and was discharged 40 days after transplantation. Ribavirin and interferon-alpha were provided for 3 months postoperatively to prevent potential recurrence of HCV infection. Serum HCV-RNA by RT-PCR became negative after such treatment.

CONCLUSIONS

End-stage liver disease in patients with hemophilia A can be an indication for living-related liver transplantation. Furthermore, a graft from a living-related donor with hemophilia A carrier seems to be suitable provided such individuals receive adequate support for coagulopathies.

Prognostic factors affecting disease-free survival rate following surgical resection of primary breast cancer

In order to identify the prognostic factors that significantly influence the disease-free survival rate after surgical resection of primary breast cancers, we determined tumour and lymph node grades, and immunohistochemical staining for estrogen and progesterone receptors (ER and PR), c-erbB-2, p53, bcl-2, bax and PCNA in 76 patients. Univariate analysis showed that increased grade of tumour and lymph nodes, negative immunostaining for ER, positive immunostaining for c-erbB-2, and a high PCNA index (> or = 30%) negatively influenced the disease-free survival rate, but PR, p53, bcl-2 and bax had no predictive value. Although p53 was not an independent prognostic factor by itself, the combination of p53, bcl-2, and bax proved to correlate with the disease-free survival, with the best prognosis noted in tumours negative for p53 and positive for both bcl-2 and bax, intermediate prognosis in tumours negative for p53 and positive for either bcl-2 or bax and worst prognosis in tumors negative for p53 as well as bcl-2 and bax. Tumour grade correlated positively with PCNA index, while positive staining for ER correlated negatively with tumour grade as well as with PCNA index, although this was statistically insignificant. Immunostaining of breast cancers for bcl-2 correlated negatively with tumour grade and PCNA index. Immunostaining for c-erbB-2 correlated positively with PCNA but not with tumour grade. Immunostaining for p53 tended to correlate positively with PCNA, but not with tumour grade. Immunostaining for PR and bax did not correlate with tumour grade and PCNA index. These results suggest that in addition to tumour size and lymph node involvement, immunostaining for ER, c-erbB-2, and a high PCNA index are important prognostic factors in human breast cancer. Wild-type p53 with preserved bcl-2 and bax gene products is also a favorable prognostic factor indicating breast cancer at an early stage of cancer progression.

Progesterone induces apoptosis in malignant mesothelioma cells

Progesterone has been used in the treatment of patients with recurrent or metastatic progesterone receptor-positive endometrial carcinoma and breast cancer. In vitro study using a breast cancer cell line, T47D, demonstrated an increase in p53 gene expression and induction of apoptosis by the administration of progesterone. Therefore, we investigated the effect of progesterone administration on the proliferation and apoptosis in a mesothelioma cell line, 211H. The expression of the progesterone receptor gene was detected in this cell line by a nested RT-PCR method. The proliferation of the cell line was suppressed after a 10-day incubation with 30 microM progesterone. In progesterone-treated 211H cells, apoptotic cells were detected by TUNEL assay and nuclear DNA fragmentation analysis. These results clearly demonstrated that progesterone administration suppressed the cell proliferation and induced apoptosis in malignant mesothelioma cells.

[Management of post liver transplantation complications]

Survival rate of liver transplanted patients is depending on management of postoperative complications. These complications include technical problems related to the operation, dysfunction of the allograft, and variety of medical complications. Differentiating and appropriately managing these diverse complications is a formidable challenge. Given the complexity of liver transplantation, it is not surprising that a variety of technical complication can occur following the operation. The most prominent of these include intraabdominal bleeding, hepatic artery thrombosis, portal vein thrombosis, and obstruction of or leak from the biliary anastomosis. In addition to these technical complications, each of which can result in dysfunction of the graft, there are a number of intrahepatic causes of graft dysfunction. The most common of these are allograft rejection, viral hepatitis and non-specific postoperative jaundice. In living related liver transplantation, primary graft non-function is rare. Accurate diagnosis and management of the various causes of graft dysfunction, whether intrahepatic or extrahepatic in origin, is very important.

Use of gastrin-releasing peptide promoter for specific expression of thymidine kinase gene in small-cell lung carcinoma cells

For specific transduction of herpes simplex virus thymidine kinase (HSV-tk) into human small-cell lung carcinoma (SCLC) cells, we explored the 5'-flanking region (-1.1 kb) of the gastrin-releasing peptide (GRP) gene as a lung cancer-specific promoter. RT-PCR analysis demonstrated expression of GRP mRNA in the SBC5 human SCLC cell line but not in the RERF human SCLC cell line, the A549 human lung adenocarcinoma cell line or the HeLa human uterine cervix epithelioid carcinoma cell line. A reporting vector containing the GRP promoter (pGL2-GRP) exhibited higher luciferase activity in SBC5 than in the other 3 cell lines. After transfecting an expression vector containing the GRP promoter-bound HSV-tk gene (pGRP-TK) into the cells, we measured their sensitivity to ganciclovir (GCV). In SBC5, pGRP-tk-transfected cells became about 100 times more sensitive to GCV than parental cells in vitro. In nude mice, tumors of pGRP-tk-transfected SBC5 regressed completely after i.p. administration of GCV. GRP promoter might be a good tool for tumor-specific transduction of suicide genes in GRP-expressing SCLC cells.

Giant hydronephrosis due to a ureteral stone, and elevated serum levels of CA 19-9

CA 19-9 is a widely used tumor marker. However, an elevation in serum CA 19-9 can occur in some patients with benign disorders such as cholecystolithiasis in the absence of tumor. We treated a case of acquired ureteral stone-induced giant hydronephrosis with markedly elevated serum CA 19-9 values. After nephrectomy, the serum CA 19-9 level returned to normal. No malignant cells were found in the tissues of the resected kidney. Localization of CA 19-9 was confirmed by immunohistochemical staining of the renal pelvic mucosa. A detailed case report is presented with a review of the literature.

Synthesis and antifungal activity of coumarins and angular furanocoumarins

Angelicin, a naturally occurring furanocoumarin, that showed antifungal activity, was considered as a lead structure for a group of synthetic coumarins. Antifungal activities of the synthesized coumarins and angelicin derivatives were reported against Candida albicans, Cryptococcus neoformans, Saccharomyces cerevisiae and Aspergillus niger. Human cell line cytotoxicity of several coumarins was evaluated against KB cells. Angelicin and several potent antifungals showed to be non-toxic in this assay.

Excision of a recurrent pericardial cyst using video-assisted thoracic surgery

A recurrent pericardial cyst manifested as an enlarging cardiophrenic cyst and was reexcised with the aid of video-assisted thoracic surgery. Video-assisted thoracic surgical excision can be a safe and effective approach, but complete excision should be performed to avoid recurrence.

Veno-right ventricular extracorporeal membrane oxygenation for thoracic surgery: an experimental study in dogs

BACKGROUND

Although the indications for extracorporeal membrane oxygenation (ECMO) have been extended, ECMO has yet to be used as a respiratory support system during thoracic surgery. The purpose of this experimental study was to investigate whether veno-right ventricular (veno-RV) ECMO can be used for thoracic surgery without mechanical ventilation.

METHODS

Acute experimental study: Veno-RV ECMO as total lung support was maintained for 60 min without mechanical ventilation in six dogs. A venous drainage cannula was inserted in the superior cavoatrial junction through the right femoral vein and a venous return cannula was inserted in the right ventricle through the right jugular vein. The veno-RV ECMO system comprised a centrifugal pump and membrane oxygenator. Survival model: After veno-RV ECMO had been established in three dogs, a two-ring thoracic tracheal segment was resected and the tracheal ends were anastomosed by video-assisted thoracic surgery without ventilation.

RESULTS

In the acute study, when the veno-RV ECMO flow was maintained at 100 mL/kg/min, all six dogs remained hemodynamically stable and the arterial oxygen saturation was maintained at more than 98%, despite total lung collapse. In the survival study, all three dogs made an uneventful postoperative recovery.

CONCLUSION

Video-assisted tracheal surgery can be performed without conventional respiratory support. Veno-RV ECMO as total lung support may become an alternative respiratory management device for thoracic surgery.

Veno-right ventricle bypass as a lung support system during pulmonary surgery without ventilation

A special lung support technique is required during carinal or tracheal surgery Veno-venous extracorporeal membrane oxygenation (ECMO) has become an accepted technique for temporary lung support. Therefore, the purpose of our experiments was to evaluate the effect of veno-venous ECMO (veno-right ventricle bypass) without ventilatory support. In five mongrel dogs, two venous drainage cannula were inserted into the superior vena cava through the right jugular vein and the inferior vena cava through the right femoral vein. In addition, a venous return cannula was inserted into the right ventricle (RV) through the right jugular vein. The veno-right ventricle (veno-RV) bypass system was composed of a centrifugal pump and membrane oxygenator; pump flow was maintained at 88 +/- 14 ml/kg/min. Excellent hemodynamics and good oxygenation were obtained. On the basis of these results, we conclude that veno-RV bypass may be used as lung support during pulmonary surgery even though the native lung is not ventilated during the veno-RV bypass procedure.

[An approach to lobectomy under a thoracoscopic surgery]

Lobectomy under a thoracoscope is a minimally invasive surgery and full consideration must also be given to the length of access thoracotomy and the number of access ports inserted. On the other hand, securing a full visual field within a limited access and treating the pulmonary artery/vein and bronchus safely and for sure are needed. However, it would not be too much to say that the easiness of lobectomy under a thoracoscope depends on the length of access thoracotomy and the number of access ports inserted. In the experiment this time we discussed an approach to the access area in lobectomy under a thoracoscope in our cases.

An updated report of a case of lung cancer resected using cardiopulmonary bypass

Although surgical intervention for advanced lung cancer invading the aortic wall is challenging, we successfully carried out such radical surgery under cardiopulmonary bypass as previously reported in this journal. One patient has now been followed for more than 5 years after the operation, so that we conclude if there is no evidence of metastatic cancer in selected patients then complete resection should be attempted using circulatory support, with the hope of an occasional cure.

Primary solitary amyloidoma of the lung: findings on CT and MRI

Pulmonary amyloidoma is a rare disease which is usually found incidentally on chest radiographs in asymptomatic, elderly people. Amyloid nodules may be solitary or much more commonly multiple. There have been many reports of radiological findings of pulmonary amyloidosis; however, those have not been characteristic. We report the findings on CT and MRI of a proven primary pulmonary amyloidoma in an asymptomatic 76-year-old woman. The low intensity of the lesion on T2-weighted images may be useful in the differential diagnosis from bronchogenic carcinoma.

[A case of solitary sternal metastasis from unknown primary hepatocellular carcinoma]

We report a 61-year-old male patient who was admitted to our hospital for treatment of a rapidly growing tumor on the anterior chest. Chest roentgenography and chest CT scan showed a mass lesion extending to the subcutaneous tissue over the sternum. Although no primary lesion was revealed by subsequent examination and needle biopsy, en-bloc resection of the chest wall tumor was performed because the patient complained of chest pain and the tumor was growing rapidly. Reconstruction of the chest wall was performed using Marlex mesh and bonecement, and the skin defect was repaired with a rectus abdominis musculocutaneous flap. No complications were observed. The pathological diagnosis of the resected specimen was a metastatic sternal tumor from a primary hepatocellular carcinoma. However, postoperative evaluation failed to detect the primary lesion in the liver. Nine months after the operation, the patient remains alive and well without evidence of hepatocellular carcinoma or recurrence. To our knowledge, reports of solitary sternal metastasis from unknown primary hepatocellular carcinoma seem to be rare.

[Combined chemotherapy with MMC, ADM, CDDP, etoposide (VP-16) and 5'-DFUR, (MACVD therapy) as a second-line chemotherapy for metastatic gastric cancer: three cases]

Three patients with chemotherapeutically pretreated metastatic gastric cancer were given MAC-VD therapy combining MMC, ADM, CDDP, Etoposide (VP-16) and 5'-DFUR. All were evaluable for their responses. Patients ranged in age from 49 to 61 years. Performance status scale (P.S.) grade 0 was two cases; and P.S. grade 1 was one case. The overall response rate, CR+PR, was 0+2/3 (66.7%). The response rate in the primary lesions was 0%, against 66.7% (2/3) in the liver, 100% (1/1) in the spleen, 100% (1/1) in the lung, and 0% in the abdominal lymph node metastasis. The chief manifestations of toxicity were hematologic, such as leukocytopenia, anemia and thrombocytopenia in 100% of the cases. Non-hematologic toxicity was seen in alopecia in 66.7%, diarrhea in 33.3%, fever in 33.3%, and pigmentation in 33.3%. Severe toxicity was not observed. From these data, the administration of MAC-VD therapy was considered tolerable and these data suggested that this therapy could be given as a second-line chemotherapy when initial treatment failed to obtain a response after a partial response.

[Surgical results of elderly patients with valvular heart disease in acute surgical stage and late follow-up]

Surgical and late follow-up results were compared between 40 elderly patients over 70-years-old (group I) and 43 patients aged from 65 to 69-years-old (group II) with acquired valvular heart disease. There was one hospital death in group I, and two hospital deaths in group II. There was no difference between group I and group II in the rate of hospital mortality of the occurrence of the surgical complications. Postoperative respiratory failure did not occur even in the elderly patients with preoperatively impaired vital capacity (%VC below 60%). Postoperative cardiac function after aortic valve replacement for aortic stenosis in elderly patients more significantly improved in comparison with preoperative function. Survival rate was 62% in group I and 78% in group II from actual survival curve at 9 year after surgery by Kaplan-Meier method. Late survival rate and cardiac event free rate were not significantly different between group I and II. Surgical results in elderly patients with valvular heart disease were satisfactory.

Carinal reconstruction under veno-venous bypass using a percutaneous cardiopulmonary bypass system

We report two patients who underwent carinal resection and reconstruction for advanced lung cancer under veno-venous bypass. The bypass system consisted of a centrifugal pump and a hollow-fiber membrane oxygenator, and was established by percutaneous insertion of cannulas through the femoral veins using the Seldinger technique. This respiratory support system under veno-venous bypass was safe and useful for carinal reconstruction, providing a good visual field and adequate oxygenation. Although other standard accepted ventilation techniques can be used for carinal resection, veno-venous bypass is an alternative adjunct in cases involving difficult carinal reconstruction.

[Surgical treatment for Stanford type A acute aortic dissection]

From March 1983 to September 1994, 53 consecutive patients underwent an emergency operation for type A acute aortic dissection. Eighteen patients before 1988 (Group I) underwent simple ascending aortic replacement (n = 13) and composite graft replacement (n = 5) by conventional method. Thirty-five patients after 1989 (Group II) underwent extended ascending aortic replacement (n = 17), hemiarch replacement (n = 6), total arch replacement (n = 8) and composite graft replacement (n = 4) using a brief period of circulatory arrest. The overall hospital mortality rate was 36.8% in Group I and 25.7% in Group II. The survivals after initial operation was 47% at 10 years (Kaplan-Meier) and the event free rate was 78% at ten years, respectively. Computed tomographic scanning and aortogram demonstrated the patent false lumen in 20 patients (64.5%) at the descending thoracic aorta. In conclusion, extended ascending aortic replacement is the useful operative technique to perform accurate resection of intimal disruption and clamp-site aorta because the replacement of the entry site could reduce the risk of operative mortality and reoperation. Total arch replacement is not necessarily required, if the entry is properly resected by extended ascending aortic replacement or hemiarch replacement. Close follow-up must be considered at the patients with patent false lumen, especially in patient with Marfan's syndrome.

Increased frequency of apolipoprotein epsilon 2 allele in non-insulin dependent diabetic (NIDDM) patients with nephropathy

The genetic polymorphism of apolipoprotein E (epsilon 2, epsilon 3 and epsilon 4) is associated with lipid abnormalities. It has been suggested that lipid abnormalities may contribute to the development and progression of kidney diseases, including diabetic nephropathy. Thus, in this study we compared the apo E allele frequencies among 146 non-insulin-dependent diabetic (NIDDM) patients with nephropathy, 135 NIDDM patients without nephropathy and 576 of the general Japanese population. The epsilon 2 allele frequency was significantly higher in diabetic patients with nephropathy (7.2%) and with renal failure (9.7%) than in diabetic patients without nephropathy (2.6%) and in the general Japanese population (3.7%). It is concluded that there is a possibility that the epsilon 2 allele is associated with nephropathy in NIDDM.

Role of SH-PTP2, a protein-tyrosine phosphatase with Src homology 2 domains, in insulin-stimulated Ras activation

SH-PTP2 is a nontransmembrane human protein-tyrosine phosphatase that contains two Src homology 2 (SH2) domains and binds to insulin receptor substrate 1 (IRS-1) via these domains in response to insulin. The expression of a catalytically inactive mutant of SH-PTP2 (containing the mutation Cys-459-->Ser) in Chinese hamster ovary cells that overexpress human insulin receptors (CHO-IR cells) markedly attenuated insulin-stimulated Ras activation. Expression of mutant SH-PTP2 also inhibited MAP kinase activation in response to insulin but not in response to 12-O-tetradecanoyl phorbol-13-acetate. In contrast, the insulin-induced association of phosphoinositide 3-kinase activity with IRS-1 was not affected by the expression of inactive SH-PTP2. Furthermore, the expression of mutant SH-PTP2 had no effect on the binding of Grb2 to IRS-1, on the tyrosine phosphorylation of Shc, or on the formation of the complex between Shc and Grb2 in response to insulin. However, the amount of SH-PTP2 bound to IRS-1 in insulin-treated CHO-IR cells expressing mutant SH-PTP2 was greater than that observed in CHO-IR cells overexpressing wild-type SH-PTP2. Recombinant SH-PTP2 specifically dephosphorylated a synthetic phosphopeptide corresponding to the sequence surrounding Tyr-1172 of IRS-1, a putative binding site for SH-PTP2. Additionally, phenylarsine oxide, an inhibitor of protein-tyrosine phosphatases, inactivated SH-PTP2 in vitro and increased the insulin-induced association of SH-PTP2 with IRS-1. These results suggest that SH-PTP2 may regulate an upstream element necessary for Ras activation in response to insulin and that this upstream element may be required for the Grb2- or Shc-dependent pathway. Furthermore, these results are consistent with the notion that SH-PTP2 may bind to IRS-1 through its SH2 domains in response to insulin and dephosphorylate the phosphotyrosine residue to which it binds, thereby regulating its association with IRS-1.

Apolipoprotein E2, renal failure and lipid abnormalities in non-insulin-dependent diabetes mellitus

The association of apolipoprotein E (apo E) genetic polymorphism, particularly apo E2, with renal failure (plasma creatinine > or = 1.4 mg/dl, and urinary albumin excretion index > or = 300 mg/g.creatinine and/or persistent proteinuria) was investigated in 57 non-insulin-dependent diabetic (NIDDM) patients. Apo E2 allele frequency was significantly higher in diabetic patients with renal failure (9.6%) than in diabetic patients without renal failure (3.2%) and in the general Japanese population (3.7%). This finding suggests that apo E2 is associated with renal failure in NIDDM. In addition, to elucidate the association of apo E2 with lipid abnormalities, plasma lipid and lipoprotein levels were compared among the apo E2 (E2/2 and E3/2) and E3/3 groups of NIDDM with renal failure (n = 27) and the apo E2 (E3/2) and E3/3 groups of NIDDM with normoalbuminuria (n = 34). In diabetic patients, the apo E2 group with renal failure had significantly higher levels of plasma total cholesterol (T-chol), very-low-density lipoprotein (VLDL)-chol, triglyceride (TG), VLDL-TG and apo E than the apo E3/3 group with renal failure, and had significantly higher levels of plasma T-chol, VLDL-chol, TG and VLDL-TG than the apo E2 and E3/3 groups with normoalbuminuria. Furthermore, the apo E2 group with renal failure had significantly higher ratios of VLDL-(chol/TG) and VLDL-chol/TG (an index of remnants in plasma) than the apo E3/3 group with renal failure and the apo E2 and E3/3 groups with normoalbuminuria. These results suggest that apo E2 leads to the accumulation of TG-rich lipoprotein and remnants in plasma. It is concluded that apo E2 is associated with renal insufficiency in NIDDM and that apo E2 may be a factor that aggravates lipid abnormalities in NIDDM with renal failure.

Insulin stimulates the phosphorylation of Tyr538 and the catalytic activity of PTP1C, a protein tyrosine phosphatase with Src homology-2 domains

PTP1C is a non-transmembrane protein-tyrosine phosphatase and contains two Src homology-2 (SH2) domains. Insulin stimulated the tyrosine phosphorylation of PTP1C in human 1M-9 lymphoblast cells, in rat H35 hepatoma cells and in Chinese hamster ovary cells over-expressing both insulin receptors and PTP1C. Insulin also stimulated the tyrosine phosphorylation of a mutant PTP1C lacking SH2 domains in Chinese hamster ovary cells, suggesting that the SH2 domains are not required for insulin-stimulated tyrosine phosphorylation of PTP1C. The insulin receptor tyrosine kinase catalyzed the tyrosine phosphorylation of PTP1C in a cell-free system. Peptide mapping of phosphorylated PTP1C showed that Tyr538 in the C-terminal region was phosphorylated in response to insulin. The tyrosine phosphorylation of PTP1C by the insulin receptor kinase increased phosphatase activity. Furthermore, PTP1C was shown to bind to autophosphorylated insulin receptors through its C-terminal region, but PTP1C did not bind to unphosphorylated receptors. These results suggest that PTP1C is a target protein for the insulin receptor tyrosine kinase and that the C-terminal region of PTP1C may function both in the regulation of phosphatase activity and in the association of PTP1C with autophosphorylated insulin receptors.

Molecular cloning of a human transmembrane-type protein tyrosine phosphatase and its expression in gastrointestinal cancers

To determine the expression of various protein-tyrosine phosphatases (PTPs) in human gastric cancers, cDNAs encoding conserved PTP domains were amplified by reverse transcriptase polymerase chain reaction from KATO-III cell mRNA and sequenced. Among 72 polymerase chain reaction clones, one of the cDNA sequences encoded a novel potential PTP (stomach cancer-associated PTP, SAP-1). The full length (3.9 kilobases) of the SAP-1 cDNA was further isolated from the KATO-III cell cDNA library and the WiDr cell cDNA library. The predicted amino acid sequence of the SAP-1 cDNA showed that mature SAP-1 consisted of 1093 amino acids and a transmembrane-type PTP, which possessed a single PTP-conserved domain in the cytoplasmic region. The extracellular region of SAP-1 consisted of eight fibronectin type III-like structure repeats and contained multiple N-glycosylation sites. These data suggest that SAP-1 is structurally similar to HPTP beta and that SAP-1 and HPTP beta represent a subfamily of transmembrane-type PTPs. SAP-1 was mainly expressed in brain and liver and at a lower level in heart and stomach as a 4.2-kilobase mRNA, but it was not detected in pancreas or colon. In contrast, among cancer cell lines tested, SAP-1 was highly expressed in pancreatic and colorectal cancer cells. The bacterially expressed SAP-1 fusion protein had tyrosine-specific phosphatase activity. Immunoblotting with anti-SAP-1 antibody showed that SAP-1 is a 200-kDa protein. In addition, transient transfection of SAP-1 cDNA to COS cells resulted in the predominant expression of a 200-kDa protein recognized by anti-SAP-1 antibody. SAP-1 is mapped to chromosome 19 region q13.4 and might be related to carcinoembryonic antigen mapped to 19q13.2.

Alteration of lipoprotein(a) concentration with glycemic control in non-insulin-dependent diabetic subjects without diabetic complications

Recently, a high plasma level of lipoprotein(a) [LP(a)] has been considered an independent risk factor for atherosclerosis and its sequelae, particularly myocardial infarction. Patients with non-insulin-dependent diabetes mellitus (NIDDM) have an increased mortality rate from cardiovascular and cerebrovascular disease. Therefore, plasma concentrations of Lp(a) were determined and the relationship between fasting plasma Lp(a) level and diabetic control was investigated in NIDDM patients without any diabetic complications. Fasting plasma Lp(a) levels were measured using enzyme-linked immunosorbent assay kits [Terumo Medical Corp, Elkton, MD, Lp(a)] in 61 NIDDM subjects (30 men aged 56 +/- 2.0 years, 31 women aged 53 +/- 2.1 years [mean +/- SEM]) who were without any diabetic macroangiopathy and microangiopathy such as retinopathy, nephropathy, and neuropathy and in 56 healthy age- and sex-matched controls. Plasma Lp(a) levels were significantly higher in the diabetic group than in the control group (23.5 +/- 2.5 v 11.7 +/- 1.4 mg/dL [mean +/- SEM], P < .001). There was no significant correlation between log-transformed plasma Lp(a) levels and other factors such as age, sex, body mass index (BMI), blood pressure, duration of diabetes, fasting plasma glucose (FPG) level, glycosylated hemoglobin (HbA1C) level, and plasma lipid levels except for low-density lipoprotein cholesterol (LDL-C) levels in diabetic patients. A significant positive correlation was noted in diabetic patients between the changes of log Lp(a) and HbA1C levels after a 3-month follow-up period (P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Radical operation using cardiopulmonary bypass for lung cancer invading the aortic wall

We report data on two patients with advanced non-small-cell lung cancer invading the aorta, who underwent successful radical operation under cardiopulmonary bypass. One patient (case 1) has been followed up for more than 16 months after the operation without any evidence of local recurrence of the tumor or distal metastases. Although this surgical intervention for an advanced lung cancer invading the aortic wall might be a challenge, we believe that such an aggressive surgical intervention is justified if cure is anticipated.

Effects of apolipoprotein E polymorphism on plasma lipoprotein(a) levels

Effects of apolipoprotein E (apo E) genetic polymorphism on plasma lipoprotein(a) (Lp(a)) levels were investigated in 305 civil service workers (158 men and 147 women). Plasma Lp(a) levels were measured by ELISA. Apo E phenotypes were determined from plasma by isoelectric focusing, Western blotting and immunostaining, as we previously reported. A total of 305 subjects were divided into the three apo E groups; apo E2 group (n = 19 for apo E3/2 and n = 4 for apo E4/2), Apo E3/3 group (n = 224) and apo E4/3 group (n = 58). Mean levels of plasma Lp(a) were 14.2 mg/dl. Plasma Lp(a) levels were significantly lower in the apo E2 group (6.6 mg/dl) than in the apo E3/3 (15.1 mg/dl) and E4/3 (13.7 mg/dl) groups. Plasma total cholesterol (T-chol) and low density lipoprotein (LDL)-chol levels were significantly lower in the apo E2 group than in the apo E4/3 group and tended to be highest in the apo E4/3 group. A significant positive correlation was noted between plasma Lp(a) levels and plasma LDL-chol levels, indicating that the effects of apo E polymorphism on plasma Lp(a) levels were parallel to its effects on plasma LDL-chol levels. In women plasma Lp(a) levels were significantly lower in the apo E2 group than in the apo E3/3 and E4/3 groups, whereas in men plasma Lp(a) levels tended to be lower in the apo E2 group but no significant difference was noted among the three apo E groups. It is concluded that plasma Lp(a) levels are, at least in part, modulated by apo E polymorphism (particularly apo E2) and that there is a gender difference in the effects of apo E polymorphism on plasma Lp(a) levels.

A novel tyrosine kinase, hyk, expressed in murine embryonic stem cells

To identify tyrosine kinases which play roles in mammalian early development, the 3' rapid amplification of cDNA ends (RACE) was performed on mouse embryonic stem (ES) cells. Among eight tyrosine kinases thus identified, we report here a novel tyrosine kinase, hyk (adhesion structures linked tyrosine kinase). The sequences of the 4.7 kb cDNA indicated the presence of RGD motif and three epidermal growth factor-like domains put between two immunoglobulin-like domains and three fibronectin type III domains in its extracellular region. It is strongly expressed in ES cells and later stages of embryos, but at low levels in midgestation embryos. It is also expressed at a low level in neural precursor cells from 10-day embryos, but at high levels in embryonic day 15 and neonatal brains. In adult tissues it is expressed ubiquitously.