[Surgical repair of type A aortic dissection with severe atherosclerosis; report of a case].

We report a case of type A aortic dissection with severe atherosclerosis. An 81-year-old man with acute type A aortic dissection was referred to our hospital. Computed tomography revealed DeBakey type II dissection with severe atherosclerosis. Ascending aortic replacement was performed urgently, and an autologous pericardium strip was placed in the lumen to prevent atheroembolization and to reinforce the friable atherosclerotic intima This technique was useful for avoiding cerebral vascular accidents. The patient was discharged on the 24th operative day with no complications.

Lidocaine inhibits priming and protein tyrosine phosphorylation of human peripheral neutrophils.

The addition of agents, such as tumor necrosis factor-alpha, to human peripheral neutrophils (HPPMN) induces priming, which enhances the receptor-mediated superoxide (O2-) generation and tyrosine phosphorylation of several HPPMN proteins. Lidocaine, a local anesthetic, inhibited both enhanced O2- generation and tyrosine phosphorylation of a 115 kDa protein in a concentration- and time-dependent manner. Lidocaine also inhibited protein kinase C sensitive O2- generation induced by phorbol myristate acetate, but not time dependently. Furthermore, lidocaine inhibited O2- generation by non-primed HPPMN induced by formylmethionyl-leucyl-phenylalanine, but this inhibition needed a higher concentration of lidocaine compared with that of primed HPPMN. These results suggest that lidocaine inhibits the priming step of neutrophil activation and that it is linked to the inhibition of tyrosine phosphorylation of a 115 kDa protein.

Allelic imbalance and microsatellite instability in plasma DNA released from polyclonal pancreatic adenocarcinoma.

Evidence of circulating soluble DNA in blood-stream of cancer patients has emerged. Because the plasma DNA is largely derived from cancer cells, genetic analysis of plasma DNA is important to understand the molecular events occurred in cancer patient. Seven microsatellite markers in the soluble plasma DNA from patients with pancreatic adenocarcinoma and other pancreato-biliary malignant tumors were examined for microsatellite instability (MSI) and allelic imbalance (AI). A variety of genetic alterations including MSI and AI were detected in the plasma DNA. Some alterations were detected before recurrence of the tumor was verified. Analysis of five primary pancreatic adenocarcinomas by microdissection revealed that the heterogeneous nature of pancreatic tumors is associated with both MSI and AI in the same tumor. The presence of altered plasma DNA including MSI and/or AI from the same pancreatic cancer patient may be important evidence for the presence of these alterations in heterogeneous primary tumors. Analysis of plasma DNA could become one of the diagnostic or therapeutic measures for this type of pancreatic adenocarcinoma.

Local antibody production and immune complex formation in rats experimentally infected with Angiostrongylus cantonensis.

The systemic humoral immune responses and tissue localization of worm-antigen, antibodies (IgG), and complement (C3) were examined in rats experimentally infected with Angiostrongylus cantonensis. While the worms remained in the subarachnoid space, it was infiltrated with plasma cells and lymphoid cells containing IgM and IgG. When the infiltration of these cells became more pronounced, the serum antibody titer began to increase. At the same time, deposits of IgM, IgG, and C3 were found in the glomeruli of the kidney. A number of eggs were observed in the lungs, enclosed in granulomatous tissues. Infiltrates of plasma cells including IgM and IgG, and deposits of IgM, IgG, and C3 were detected around the eggs and in the granulomatous tissues. A marked increase in serum antibody was observed. A. cantonensis larvae induce local antibody (IgM and IgG) production in the central nervous system prior to an increase of serum antibody titer. Measurement of cerebrospinal fluid antibody titer at an early stage of infection may confirm infection. The larvae showed no evidence of damage in spite of marked local antibody production in the central nervous system. The eggs in the lungs stimulated both local and systemic antibody production, and immune complexes were formed in the lung and the circulatory system. Immune complexes may participate in the formation of granuloma.

Evaluation of the internal thoracic arterial graft patency by the transthoracic Doppler method under continuous intravenous infusion of adenosine triphosphate disodium.

Usefulness of the Doppler method under continuous infusion of adenosine triphosphate disodium (ATP) for improvement of accuracy in the diagnosis of the left internal thoracic arterial graft (LITA) patency was examined using transthoracic ultrasonic echocardiography. 1) Influence of ATP on the Doppler velocity in a graft was examined in 7 patients with good LITA grafts using physiological saline as the control. In the ATP group, 80 mg of ATP was dissolved in 20 ml physiological saline and continuously infused at 0.14 mg/kg/min. In the saline group, an equal volume of physiological saline was administered and the blood flow velocity in the LITA was recorded continuously by the transthoracic Doppler method from the supraclavicular fossa approach. Results; ATP administration increased the blood flow velocity in the LITA and the rate of increase was 48.3% for systolic peak velocity, 111% for diastolic peak velocity, 64.4% for systolic time velocity integral and 99% for diastolic time velocity integral indicating particularly high rates of increase in diastolic components. The diastolic/systolic peak velocity ratio or diastolic fraction did not increase significantly. In the saline group, none of the parameters showed a change. 2) Angiographic findings of the LITA were compared with the measurement values of the diastolic components by the Doppler method to examine usefulness of diastolic component measurement with ATP infusion for diagnosis of LITA patency. Subjects were 19 patients with good LITA (group A) and 8 patients with bad LITA (group B). Results; while there were significant differences in the mean baseline diastolic peak velocity, mean diastolic time velocity integral and mean diastolic fraction between the groups, overlapping was seen in individual cases. However, the inter-group differences were more distinct by ATP infusion and the borderline values were 30 cm/sec for diastolic peak velocity and 10 for diastolic time velocity integral. 3) Reliability of the diagnosis for LITA patency by measuring the diastolic components using the Doppler method with ATP infusion was examined and compared with the angiographic findings as the gold standard. Subjects were 27 patients and the diagnostic criteria for good LITA were set at 30 cm/sec for diastolic peak velocity and 10 for diastolic time velocity integral. Results; sensitivity and specificity of the Doppler method with ATP infusion were 100% for diagnosis of LITA patency by measuring the diastolic components. Conclusion, in diagnosis of LITA patency by the transthoracic ultrasonic cardiography, diagnostic accuracy was improved by measuring the diastolic parameters under continuous infusion of ATP.

[Epidural anesthesia for a patient with catamenial pneumothorax].

Endometriosis extending into the thoracic cage or the lung might induce defect of the tissue and show catamenial symptoms, such as pneumothorax or hemothorax. These events usually occur 48 to 72 hours after menstruation. A 37-year-old woman with ten year history of recurrent catamenial pneumothorax was scheduled for removal of ovarian cyst. Since intermittent positive pressure ventilation or pneumoperitoneum might induce pneumothorax, we selected epidural anesthesia for laparotomy. Epidural cannulations were performed at Th 9/10 and L 4/5 interspaces. After administration of 2% mepivacaine (400 mg) and fentanyl (0.1 mg), the block extended from Th 6 to S 5. The surgery was done without any complication. In this case epidural anesthesia for laparotomy was useful for the patient with catamenial pneumothorax.

[Cephalad movement of the carina due to CD (Cotrel-Dubousset) instrumentation for idiopathic scoliosis].

Recently we experienced a case of tracheal tube obstruction due to the upward displacement of carina during CD (Cotrel-Dubousset) instrumentation for idiopathic scoliosis. Therefore, we hypothesized that CD instrumentation may affect the position of the carina as a result of correction of chest deformity, and studied the displacement of carina before and after CD instrumentation on chest X-ray in 12 patients with scoliosis. The length between the bottom of the 6th cervical vertebral body and the carina was measured by using chest X-ray before and after the correction. In all patients studied, cephalad movement of the carina was observed, and it was more than 1.00 cm in 5 patients. The maximal movement of the carina was 1.59 cm. The tracheal length after the correction was significantly shorter than before (P < 0.01). These results suggest that the carina may be displaced upwards due to the correction by the CD instrumentation, and that such induced displacement may affect the tracheal tube position and obstruct the tube during the operation.

Mandibular alveolar ridge extension method using a surgical splint with porous hydroxyapatite (HAP) particles.

The mandibular alveolar ridge extension method is a surgical technique to extend the alveolar ridge up to the required level. Using a surgical splint prepared to meet the clinical requirements establishes the desirable alveolar ridge extension with porous hydroxyapatite (HAP) particles. Before the operation, a working cast of the extremely resorpted mandibular alveolar ridge is remodeled into its desired shape with paraffin wax, and the extended surgical splint is cured by clear acrylic resin. After subperiosteal tunnel dissection, the surgical splint is fixed to the mandible with circummandibular ligatures; then the HAP particles are injected into the tunnel. After healing, a treatment denture is cured between the artificial dentition and the surgical splint with self curing resin. In this method, the HAP particles are injected into the subperiosteal tunnel that is created between the surface of alveolar bone and the periosteum covered by the surgical splint; the migration of HAP particles completes the extension of the alveoral ridge.

Inhibition of mushroom-tyrosinase by aloe extract.

Inhibition by ALOE extracts of L-dopa oxidation by mushroom-tyrosinase was examined. 2''- O-Feruloylaloesin and aloesin at concentrations of 0.4 microM showed inhibition of 27 and 30%, respectively. Lineweaver-Burk plots of the concentration of L-dopa in the absence and presence of 2''- O-feruloylaloesin, 0.4 and 0.8 microM, showed that this compound inhibits mushroom-tyrosinase noncompetitively. The K (i) value obtained was 8.5 x 10 (-5) M. 2''- O-Feruloylaloesin and aloesin contents were analyzed by a reversed-phase HPLC, and their seasonal variations were observed.

Anemia and anti-erythrocyte antibodies developed after repeated injections of sonicated preparations of Plasmodium berghei and Babesia rodhaini.

Anemia developed in mice after repeated injections of sonicated preparations of Plasmodium berghei and Babesia rodhaini. Anti-erythrocyte antibodies were detected in sera by an enzyme-linked immunosorbent assay and their levels rose as anemia developed. Administration of carbon particle suspension to block the mononuclear phagocyte system was effective to inhibit anemia induced by injections of sonicated parasite preparations. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting analyses were carried out to examine autoantigens on the surface of the erythrocyte membrane reacting to anti-erythrocyte antibodies. The anti-erythrocyte antibodies from mice injected with the sonicated P. berghei preparations bound specifically to three components of the erythrocyte membrane. The anti-erythrocyte antibodies produced by the sonicated B. rodhaini preparations also reacted with four components, two of which corresponded to those reacting after the injection of the sonicated P. berghei preparations. These results suggest that both P. berghei and B. rodhaini organisms have some materials capable of inducing production of the anti-erythrocyte antibodies which mediate erythrophagocytosis by macrophages of the mononuclear phagocyte system during Plasmodium and Babesia infections.

Potentiation of the cardiovascular effects of nicardipine by enflurane anesthesia in canine blood-perfused heart preparations.

The cardiovascular interaction between nicardipine (N) and enflurae (E) was examined with blood perfused isolated paplillary muscle preparations (PMP) and sinoatrial node preparations (SNP). Blood flow to these preparations was supplied by either conscious or 1.7% E-anesthetized-donor dogs. N was administered continuously at a rate of 2.0 microg.kg(-1).min(-1) into the donor dogs for 60 min. Measurements were as follows: mean arterial blood pressure (MAP), heart rate (DHR), PQ interval (PQ) in the electrocardiogram, developed tension (DT) in PMP, sinoatrial rate (SAR) in SNP and blood flow (BF) to PMP and SNP. There were no significant differences in PQ, SAR and BF between two groups. However, N further decreased MAP, DHR and DT that were already decreased by E significantly. The authors conclude that the cardiovascular interaction between N and E was generally additive but that concerning negative inotropism was synergistic.

Perthes' disease--a classification based on the extent of epiphyseal and metaphyseal involvement.

A tentative classification of Perthes' disease according to the extent of epiphyseal and metaphyseal involvement in lateral radiographs of the hip was applied to 61 hips in 55 patients. Forty-four hips were treated by containment (Tachjian's trilateral socket hip abduction orthosis) and 17 hips were treated surgically either by intertrochanteric or sub-trochanteric osteotomy. The results correlated well with the classification of the authors. The greater the extent of involvement of the epiphysis and metaphysis, the severer the resulting deformity. The choice of method of treatment is also discussed. It is concluded that this classification may be of prognostic value and may be useful to differentiate atypical cases.

Billroth I gastrectomy using a circular stapler to treat gastric cancer.

We describe herein our technique of performing gastrectomy followed by side-to-end gastroduodenostomy. Because the clamp is removed at the resection line of the greater curvature, there is no need to perform an additional gastrotomy for insertion of the instrument. This feature differentiates our technique from previous methods of anastomosis using the circular stapler. We believe that our technique is superior in simplicity and security to the traditional hand-sewn anastomosis. Moreover, it allows for a shorter operative time. This technique is recommended for practical surgery over conventional techniques.