Alcohol consumption promotes the intestinal translocation of Streptococcus suis infections.

Streptococcus suis is an emerging zoonotic agent. This study aimed to investigate whether S. suis is likely to translocate across the intestines of human hosts who have liver disease and/or consume alcohol. Both the alcoholism and cirrhosis models exhibited high mRNA expression of TGF and collagen1, but only the cirrhosis model had fibrosis in the liver. After both models were infected with S. suis, significantly different concentrations of S. suis were detected in the blood and brains of the alcoholism model (Blood: 36.4%; Brain: 31.8%) and the cirrhosis model (Blood: 62.5%; Brain: 62.5%) compared to the concentrations in the healthy mice (Blood: 15.4%; Brain: 0%). Trans-epithelial electrical resistance (TER) was used to examine the Caco-2 cells in the in vitro that had an S. suis infection combined with 1% ethanol. Although the ethanol did not influence the Caco-2 cells' barriers, it did rapidly decrease the barriers' TER value and then their E-cadherin compared to the infected Caco-2 cells without the ethanol treatment. Immunofluorescence also indicated that the barriers of the Caco-2 cells treated with ethanol were disrupted and that S. suis translocated from the apical to the basolateral side. This study demonstrated that alcohol consumption helped S. suis to translocate.

Clinical features of a new disease concept, IgG4-related thyroiditis.

OBJECTIVES: Immunoglobulin (Ig)G4-related disease is a recently proposed systemic disorder that includes autoimmune pancreatitis (AIP), Mikulicz's disease, and various other organ lesions. In the present retrospective study, we examined whether thyroid lesions should also be included in IgG4-related disease (Ig4-RD) under the new term IgG4-related thyroiditis. METHOD: We enrolled 114 patients with Ig4-RD, including 92 patients with AIP, 15 patients with Mikulicz's disease, and seven patients with IgG4-related cholangitis, and analysed clinical findings, function, serum values of activity markers, computed tomography (CT) images, and histology of the thyroid gland. RESULTS: Among the 22 patients (19%) in our cohort who were found to have hypothyroidism [thyroid stimulating hormone (TSH) > 4 mIU/L], 11 patients had clinical hypothyroidism [free thyroxine (FT4) < 1 ng/dL] and 11 patients had subclinical hypothyroidism (FT4 ≥ 1 ng/dL). Serum concentrations of IgG, IgG4, circulating immune complex (CIC), and ß2-microglobulin (ß2-MG) were significantly higher in the hypothyroidism group compared with the remaining 92 euthyroid patients, and serum C3 concentration was significantly lower. After prednisolone treatment, TSH values had decreased significantly (p = 0.005) in this group and FT4 values had increased significantly (p = 0.047). CT images showed that the thyroid glands of patients with clinical hypothyroidism had a significantly greater volume than those of the euthyroid and other groups. Pathological analysis of one resected thyroid gland disclosed a focused lesion with infiltration of lymphocytes and IgG4-bearing plasma cells and loss of thyroid follicles. CONCLUSIONS: Thyroid lesions associated with hypothyroidism can be considered as a new disease termed IgG4-related thyroiditis. Awareness of this condition should lead to appropriate corticosteroid treatment that may prevent progression to a fibrous state.

Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy.

BACKGROUND: Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy. METHODS: The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices. RESULTS: This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 103, 95 per cent c.i. 19.6 to 3.8 × 107; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not. CONCLUSION: The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

Biological and biochemical activity of E7 genes of the cutaneous human papillomavirus type 5 and 8.

In contrast to the observed activity of the E7 genes of the genital high-risk human papillomavirus (HPV)16 and HPV18, E7s of the cutaneous high-risk HPV5 and HPV8 show no in vitro transforming activity in established rodent cells. We recently reported that the HPV8 E7 driven by the SV40 enhancer/promoter oncogenically transforms primary rat embryo fibroblast (REF) cells collaboratively with the EJras oncogene (Jpn. J. Cancer Res., 82, 1340-1343, 1991). To study the functional differences between cutaneous HPV5 and HPV8 E7s and genital HPV16 E7, we cloned each of the E7 open reading frames and tested their immortalizing and transforming activities, the binding ability of their products with retinoblastoma protein (RB) and their complementation activity of a RB-nonbinding adenovirus E1A mutant. In contrast to results with HPV16 E7, transfection of HPV5 and HPV8 E7s did not produce any G418-resistant colonies in primary baby rat kidney (BRK) cells. However, they induced morphological transformation of primary BRK cells as well as of primary REF cells when cotransfected with the EJras oncogene. The ras-cooperating activity of HPV8 E7 appears to be extremely low, since, unlike the case of HPV5 and HPV16 E7s, transformed BRK colonies induced by HPV8 E7 plus ras have had a very low survival rate. The in vitro RB binding experiment showed that HPV5 and 8 E7s are able to form complexes with RB protein with reduced affinities of about one fourth and one nineteenth that of HPV16 E7, respectively. Moreover, not only HPV16 E7 but also HPV5 and 8 E7s complemented a nontransforming adenovirus 5 E1A mutant (dl922/947) incapable of binding to RB in inducing E1A-specific transformed foci on primary BRK cells. Since both the activities, the ras-collaborative transformation and complementation of the inert E1A mutant by E7s, all correlate with in vitro RB binding affinity (HPV16 E7 > HPV5 E7 > HPV8 E7), it is likely that RB binding of HPV5 and HPV8 E7s is an integral part of the biological activities of these proteins.

Mosaic structures of neurotoxins produced from Clostridium botulinum types C and D organisms.

We isolated the gene encoding a botulinum neurotoxin (BoNT) of 1285 amino acids with a molecular weight of 147,364 from the toxigenic bacteriophage d-sA of Clostridium botulinum type D strain South African (Dsa). The BoNT of Dsa (BoNT/Dsa) is composed of three regions on the basis of the homology to BoNT types C1 (BoNT/C1) and D (BoNT/D). The N-terminal (Met-1 to Val-522) and the C-terminal regions (Trp-945 to Glu-1285) have high identity to corresponding regions of BoNT/D (96% identity) and BoNT/C1 (74% identity), respectively. The core region (Pro-523 to Lys-944) is common to three toxins (83% to 92% identity). These results suggest that neurotoxins produced from Clostridium botulinum types C and D are composed in a mosaic-like fashion.

Cloning and characterization of a cDNA encoding bovine mannan-binding protein.

To identify the bovine mannan-binding protein (MBP), a search for the cDNA homologue of human MBP was carried out. cDNA clones encoding bovine MBP were isolated from a bovine liver cDNA library using a cDNA fragment encoding a short collagen region, neck domain and carbohydrate recognition domain of human MBP. The cDNA carried an insert of 747 bp encoding a protein of 249 amino acid (aa) residues with a signal peptide of 19 aa. The mannan-binding protein fraction of bovine serum that eluted with 100 mM mannose from a mannan-Sepharose column was analyzed under reducing conditions by SDS-PAGE. The major band of 33 kDa obtained reacted with anti-human MBP rabbit serum. The partial aa sequence of the purified 33-kDa protein was identical to the aa sequence deduced from the obtained cDNA. Results of the passive hemolysis experiment using sheep erythrocytes coated with yeast mannan suggest that this MBP has the ability to activate complement. Northern blot analysis showed a 1.8-kb mRNA that was expressed only in the liver. Based on results of genomic analysis, this bovine MBP is likely to be a homologue of human MBP and to also have homology to rat and mouse MBP-C which are localized in liver cells rather than to rat and mouse MBP-A found in serum. Alignments of bovine collectins show that bovine MBP cannot be included among the other bovine collectins, such as bovine SP-D, conglutinin and CL-43. Finally, these genomic and biological analyses indicate that the cDNA obtained here encoded a bovine serum MBP.

Molecular characterization of two forms of nontoxic-nonhemagglutinin components of Clostridium botulinum type A progenitor toxins.

The entire sequences of the type A nontoxic-nonhemagglutinin gene and an adjacent open reading frame designated as orf 22-a, which are located between the neurotoxin and the HA-35 genes were determined. SDS-PAGE and N-terminal amino acid sequence analyses of the purified type A progenitor toxins (12S, 16S and 19S) indicate that the nontoxic-nonhemagglutinins of 16S and 19S are single peptides of approximately 120k, but that of 12S has a cleavage at the site between Pro-144 and Phe-145 of this protein.

A pertussis toxin-sensitive GTP-binding protein plays a role in the G0-G1 transition of rat hepatocytes following establishment in primary culture.

Acute spontaneous c-myc gene expression and sustained increase of a GTP-binding protein(s) (G-protein) which is sensitive to islet-activating protein (IAP), pertussis toxin, occurred early during primary culture of adult rat hepatocytes. Following these earlier events, DNA synthesis was demonstrated in response to EGF and insulin. Addition of IAP immediately after plating of primary cultures inhibited c-myc expression and the hormone-induced DNA synthesis. Addition at 24 h or later following cell inoculation, however, produced only weak effects on DNA synthesis, even though the IAP-sensitive G-proteins were completely inactivated. We conclude that the IAP-sensitive G-protein(s) plays a role in the earlier process(es) of the G0-G1 transition, which is essential for the initiation of growth factor-dependent DNA synthesis.

Identification and characterization of functional subunits of Clostridium botulinum type A progenitor toxin involved in binding to intestinal microvilli and erythrocytes.

Clostridium botulinum type A hemagglutinin-positive progenitor toxin consists of three distinct components: neurotoxin (NTX), hemagglutinin (HA), and non-toxic non-HA (NTNH). The HA consists of four subcomponents designated HA1, 2, 3a and 3b. By employing purified toxin and GST-fusion proteins of each HA subcomponent, we found that the HA-positive progenitor toxin, GST-HA1 and GST-HA3b bind to human erythrocytes and microvilli of guinea pig upper small intestinal sections. The HA-positive progenitor toxin and GST-HA1 bind via galactose moieties, GST-HA3b binds via sialic acid moieties. GST-2 and GST-3a showed no detectable binding.

Role of connective tissue growth factor in profibrotic action of transforming growth factor-beta: a potential target for preventing renal fibrosis.

Tubulointerstitial fibrosis is a crucial process determining the progression and prognosis of various renal diseases. Connective tissue growth factor (CTGF), a novel fibrogenic protein induced by transforming growth factor-beta (TGF-beta), is upregulated in various clinical and experimental nephropathies, but the significance of CTGF in the profibrotic action of TGF-beta is still poorly defined. To explore the implication of CTGF in renal fibrosis, we investigated gene expression of CTGF, fibronectin, and alpha1(I) collagen in an obstructive nephropathy model in rats. Furthermore, to elucidate the role of CTGF in TGF-beta-stimulated extracellular matrix accumulation, we analyzed the effects of blockade of endogenous CTGF using antisense oligodeoxynucleotides (ODNs) in cultured rat renal fibroblasts. After unilateral ureteral obstruction, TGF-beta1 and CTGF messenger RNA (mRNA) expression in the obstructed kidney was coordinately upregulated from the early stage of interstitial fibrosis, followed by marked induction of fibronectin and alpha1(I) collagen mRNA expression. In cultured normal rat kidney fibroblast (NRK-49F) cells, CTGF antisense ODN transfection significantly attenuated TGF-beta1-induced fibronectin and alpha1(I) collagen mRNA expression compared with control reverse ODNs. These results indicate that CTGF has a crucial role in the profibrotic action of TGF-beta in renal fibroblasts, providing a potential therapeutic target against tubulointerstitial fibrosis.

Modulation of platelet aggregation after percutaneous transluminal angioplasty of the iliac artery for atherosclerosis obliterans.

BACKGROUND: Platelet aggregation is modulated by blood flow. We investigated whether platelet function is altered during percutaneous transluminal balloon angioplasty in patients with atherosclerosis obliterans. METHODS: Blood samples were obtained from the iliac artery in 9 lower limbs of 7 patients undergoing percutaneous balloon angioplasty of the iliac artery. An agonists-induced platelet aggregation test was performed with an aggregometer. Femoral blood flow was measured with a Doppler velocimeter before and after the procedure. RESULTS: Before dilatation, the maximum platelet aggregation rates (+/- SEM) induced by adenosine phosphate, epinephrine, and arachidonic acid were 54.7% +/- 5.8%, 64.8% +/- 4.3%, and 60.5% +/- 6.1%, respectively. After angioplasty, these values reduced to 36.7% +/- 4.1%, 36.1% +/- 8.6%, and 40.1% +/- 5.0%, respectively (P < .05). The pre-procedural ankle-brachial pressure index, mean flow rate, mean velocity, and shear stress variation were 0.63 +/- 0.1, 218.1 +/- 32.1 mL/min, 9.4 +/- 1.1 cm/sec, and 60.6 +/- 17.7 dyne/cm2, respectively. The mean velocity at the stenotic lesion was 215.1 +/- 83.9 cm/sec, which was significantly greater than those of the distal artery or after angioplasty (P < .01). Both ankle-brachial pressure index and shear stress variation increased after angioplasty to 0.99 +/- 0.07 (P < .05) and 139.8 +/- 17.0 (P < .05) dyne/cm2, but the mean flow rate and the mean velocity (198.3 +/- 24.5 mL/min and 8.8 +/- 1.2 cm/sec after angioplasty) did not change significantly. CONCLUSIONS: These results indicate that activated platelet function at a stenosed artery was decreased after angioplasty, possibly because of normalized blood flow with reduction of stenotic lesion.

Increased prostacyclin production after percutaneous transluminal angioplasty of the iliac artery for atherosclerosis obliterans.

BACKGROUND: Endothelial prostacyclin production is modulated by blood flow (wall shear stress). Local plasma prostacyclin concentrations and hemodynamic parameters have therefore been investigated in patients with atherosclerosis obliterans before and after angioplasty. METHODS. DESIGN: Prospective study. SETTING: Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. PATIENTS: Nine lower limbs in eight patients with significant stenoses of the iliac artery were studied. INTERVENTIONS: blood samples were obtained from the femoral artery and femoral vein of nine lower limbs undergoing percutaneous balloon angioplasty of the iliac artery. MEASURES: Prostacyclin concentrations, radioimmunoassayed as 6-keto-prostaglandin F1 alpha, were measured before and after balloon dilatation. Femoral blood flow and the ankle-brachial pressure index (ABI) were measured using a Doppler velocimeter before and after the procedure. The femoral blood flow waveform was used to calculate the mean blood flow and shear stress variation. RESULTS: Before angioplasty, the mean (+/- SEM) plasma prostacyclin concentration was 21.6 +/- 1.5 pg/ml in the femoral artery and 25.4 +/- 1.1 pg/ml in the femoral vein. After angioplasty, these values increased to 25.6 +/- 2.2 pg/ml (p < 0.05) and 32.8 +/- 1.8 pg/ml (p < 0.01), respectively. The pre-procedural ABI, mean flow rate, and shear stress variation were 0.596 +/- 0.071, 354.1 +/- 63.3 ml/min, and 69.1 +/- 9.9 dyne/cm2, respectively. Both ABI and shear stress variation increased after angioplasty to 0.738 +/- 0.076 (p < 0.05) and 111.1 +/- 24.2 (p = 0.0775) dyne/cm2, but the mean flow rate (287.1 +/- 61.1 ml/min after angioplasty) did not increase (p = 0.2002). CONCLUSIONS: These results suggest that prostacyclin production increases after angioplasty, possibly due to increases in the intraluminal pressure and shear stress variation. This enhanced prostacyclin production may help to maintain arterial or bypass graft patency.

In vivo anatomical analysis of arterial contact with trigeminal nerve: detection with three-dimensional spoiled grass imaging.

The purpose of this study was to review the normal in vivo neurovascular relationship between the trigeminal nerve and surrounding arteries without the use of volunteers. 290 nerves in 145 cases were reviewed during a 1-year period. Axial source images and multiplanar reconstructed (MPR) images were used to determine the neurovascular contact and direction of contact. Multiplanar volume reformation (MPVR) was used to identify the contact vessels and to demonstrate the relationship between the nerve and arteries. Vascular contact was found in 29% of the 290 nerves (83 nerves). The arteries involved were the superior cerebellar artery (SCA) or the anterior inferior cerebellar artery (AICA). Vascular contact with two arteries was found in 3%. Of the 286 asymptomatic nerves, the nerve was located between the two vessels in 3% and compression was seen in 1%. Three points of vascular contact by the two arteries were identified in one asymptomatic nerve. The direction of contact between the SCA and the nerve was superior (38%), superomedial (32%) or medial (15%) in most cases. The direction of contact between the AICA and the nerve was inferior, inferolateral or lateral in all cases. Vascular contact at the root entry zone (REZ) was noted in 90%. Four nerves were affected by trigeminal neuralgia, one of which touched an artery and two were compressed. It was concluded that arterial contact can be assessed without difficulty but evaluation of vascular compression is not easy.

Long-term results and prognostic factors after repair of abdominal aortic aneurysm with concomitant malignancy.

OBJECTIVE: Long-term results after repair of abdominal aortic aneurysm (AAA) with concomitant malignancy were reviewed, and factors which may affect survival were analyzed. DESIGN: Retrospective series with follow-up of three to 125 months. Setting. Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. PATIENTS: Among 112 consecutive repairs of AAA, 16 cases had concomitant malignancy. The malignant lesions included eight gastric cancers and eight other malignant tumours. The malignancies were divided using TNM Classification into an early stage (stage O or I) group (n=9) and an advanced stage (stage II, III, or IV) group (n=7). INTERVENTIONS: All aneurysms were successfully repaired, and simultaneous resection of the concomitant malignancy was performed in five cases. While 13 malignant lesions were resected completely, three could not be resected completely, but were treated by other surgical procedures. MEASURES: Survival rates were predicated using the Kaplan-Meier method. The log-rank test was used to compare survival rates. RESULTS: The one-, two-, and five-year survival rates after repair of AAA were 80%, 72% and 63%, respectively. The survival rates for the early stage group were significantly higher than those for the advanced stage group (p<0.05). Patients with concomitant gastric cancer or who underwent complete resection of the malignant lesion survived longer. CONCLUSION: In patients with concomitant AAA and malignancy, factors influencing survival for those with malignant lesions also affected survival after aneurysmectomy. Detection of early-stage concomitant malignancy and more aggressive treatment for the malignancy may improve the outcome.

Molecular typing of enterohemorrhagic Escherichia coli O157:H7 isolated in Okayama Prefecture using pulsed field gel electrophoresis and random amplification of polymorphic DNA.

Three outbreaks and many isolated cases of enterohemorrhagic Escherichia coli O157:H7 occurred in 1996 and 1997 in Okayama Prefecture, Japan. In an attempt to investigate the route of these infections, the strains isolated from the 3 outbreaks (total 33 strains) and 15 isolated cases (total 15 strains) were investigated using random amplification of polymorphic DNA (RAPD) and pulsed-field gel electrophoresis (PFGE). In addition, 10 strains from an outbreak in Tojo Cho, Hiroshima Prefecture (June 1996), 2 strains from the particular types of meat in Kochi Prefecture, and 42 strains isolated from bovine feces in a farm in Okayama Prefecture were also investigated in the same manner. PFGE was much more useful than RAPD for molecular typing of the clinical isolates, in that it allowed us to classify them into 10 PFGE groups. We noted that the strains differed according to the time and place of the outbreaks (or isolated cases). This indicates that O157:H7 infections in Okayama Prefecture were caused by different strains (although some cases were aggravated by the same strains as were found in other areas). The isolates from bovine feces were classified into 5 groups by PFGE profiles, but none of them were identical to those of the clinical isolates.

Effects of aldose reductase inhibitor (M79175) on ERG oscillatory potential abnormalities in streptozotocin fructose-induced diabetes in rats.

The effects of an aldose reductase inhibitor (M79175) on electroretinogram (ERG) oscillatory potential abnormalities was studied in rats with streptozotocin fructose-induced diabetes. The ERG oscillatory potential was recorded under scotopic conditions without general anesthesia in the diabetic rats, before and 4, 8 and 12 weeks after administration of M79175. The ERG tracings were analyzed for peak latencies, peak intervals and amplitudes; the peak latencies and intervals were prolonged and the amplitudes were reduced in untreated diabetic rats, but the prolongation of the peak latencies and intervals were suppressed in diabetic rats receiving M79175. The amplitudes were reduced in the treated rats as in the untreated rats. The results of this investigation suggest that M79175 is effective to suppress progression of diabetic retinopathy in its early stage.

[Cataract--clinic and pathology].

Clinicopathological studies were performed on 156 lenses of human senile cataract obtained by cataract operations between 1970 and 1988. It became clear that the aging influences the functional destruction of the equatorial region, the pathological changes of the bow area, and changes of the extralens environment. After operation for the atrophic type of the posterior subcapsular cataract, aftercataract easily develops on the intraocular lens and this requires treatment. Long-term observations were carried out in 180 Wistar male rats under the same laboratory condition and histological studies were performed. The similarities between the senile Wistar rat cataract and the human senile cataract indicate that the Wistar rat cataract is useful as a model for studying the human senile cataract. These rats were initially classified into six groups (control, vitamin E diet, EPC eye drops, catalin eye drops and reduced catalin eye drops). To study the effects of the agents (vitamin E, ARI, EPC, catalin, reduced catalin) on the cataract in senile Wistar rats the mean cell density of lens epithelia were measured at 2 or 3-month intervals. There were no statistically significant differences in treated groups and the control group. The results suggest that these agents affect another factor of lens apart from the proliferative activity of lens epithelial cell. Effects of anti-cataract agents were investigated using cultured lens epithelial cells. When cultured rat lens epithelial cells were incubated in medium containing selenite, super-oxide dismutase (SOD) activity and GSH in the cells markedly decreased, and GSSG was markedly increased. When cultured rabbit lens epithelial cells were incubated in medium contained selenite and glutathione, SOD activity was maintained normal level. When cultured lens epithelial cells were incubated in medium contained selenite and pirenoxin, SOD activity also maintained a normal level. These results suggest that both glutathione and pirenoxin are effective as anti-cataract agents. Cataracts in spontaneously hypertensive rats (SHR) was investigated on male of Wistar-Kyoto rats (WKY), stroke resistant SHR (SHRSR) and stroke-prone SHR (SHRSP) rats aged 3 to 9 months. Cataracts in these rats were classified as follows: Type 0: no opaciiy, Type 1: nuclear opacity, Type 2: posterior subcapsular opacity, Type 3: nuclear opacity associated posterior subcapsular opacity and Type 4: complete opacity in both lenses. Incidence of cataract in WKY was 2.6%, SHRSR, 76.8% ant SHRSP, 88.2%. Incidence of nuclear opacity was remarkably higher in SHRSP (48.5%). In SHR aged from 3 to 5 months, nuclear opacity was ahead of the appearance of posterior subcapsular opacity which was increased during aging.(ABSTRACT TRUNCATED AT 400 WORDS)

[The usefulness of dipyridamole stress myocardial scintigram as a preoperative test for detecting ischemic heart disease before vascular surgery].

We evaluated the usefulness of dipyridamole 201Tl myocardial scintigraphy (DS) for detecting myocardial ischemia in 18 candidate for vascular surgery. DS indicated significant thallium redistribution in 6 patients. Coronary angiography was performed in 5 of these 6 patients and revealed significant coronary artery disease in all patients. As a result, operation was cancelled in 4 patients with severe coronary artery disease. One of these cases died of acute myocardial infarction after being discharged from hospital. One other patient was operated after percutaneous transluminal coronary angioplasty. Another patient was operated knowing that he had significant but mild coronary artery disease. Subsequently, operations were performed in 14 patients. No serious cardiac event occurred in these 14 patients except one case with T wave inversion without myocardial enzyme elevation. Thus, we concluded that DS was a useful method for detecting ischemic heart disease and prevent cardiac event associated with vascular surgery.

[PTCA and coronary artery bypass operation prior to subsequent surgery of gastric cancer in patients with coronary artery disease].

Two patients with coronary artery disease required operation for gastric cancer. In one patient with single vessel disease, 37 days later after successful PTCA, gastric resection for early gastric cancer was performed without any cardiac complication. The other patient with severe three vessel disease initially underwent coronary artery bypass operation, and 13 days later gastric resection for advanced cancer was performed. This patient developed supraventricular arrhythmia as a sole complication which was easily controlled by medical treatment. In both cases, fentanyl was used as an anesthetic agent and nitroglycerin was continuously administered intravenously during the perioperative period. ECG, central venous pressure, and direct arterial pressure were also carefully monitored. We feel that noncardiac operation such as gastric resection can be performed without major cardiac complications even shortly after coronary artery bypass operation.

[Catheter-induced thrombosis of the inferior vena cava--case report].

A 47-year-old woman was admitted for bleeding from gastric ulcer for which a central venous catheter was placed through the right femoral vein. Seven days later, abdominal echograms unexpectedly revealed a large thrombus along the catheter in the inferior vena cava. Because the echograms also disclosed the thrombus immobile even in postural change, the catheter was pulled out. Within two weeks following the catheter removal, the thrombus spontaneously disappeared with no evidence of pulmonary embolism. Although thrombolysis therapy may be the treatment of choice for catheter-induced thrombosis, simple removal of the catheter is effective in case that the thrombus is immobile.