Molecular analyses of GYPB in African Brazilians.

The molecular background of variant forms of GYPB is not well studied in Brazilians of African descent. The present study was carried out to determine the molecular bases of the S-s- phenotype and the frequency of GYPB*S silent gene for the S-s+ phenotype in a blood donor population of African Brazilians. In this study, 165 blood samples from African Brazilians (Northeastern Brazil) who phenotyped as S-s- (n = 17) and S-s+ (n = 148) by hemagglutination were selected. Allele-specific (AS)-PCR and PCR-restriction fragment length polymorphism (RFLP) were used to identify the variant forms of GYPB. In 13 of 17 S-s- samples (76.5%), both GYPB were deleted. In 137 of the 148 S-s+ samples (92.6%), the AS-PCR was consistent with the S-s+ phenotype. In 4 of the S-s- samples (23.5%) and 11 of the S-s+ samples (7.4%), the AS-PCR showed the presence of a GYPB*S allele associated with silencing of S. In the 4 donors with the S-s- phenotype, there was homozygosity (or hemizygosity) for the GYP(P2) allele (n = 2), homozygosity (or hemizygosity) for the GYP(NY) allele (n = 1), and heterozygosity for the GYP(P2) and GYP(NY) alleles (n = 1). In the 11 donors with the S-s+ phenotype, there was heterozygosity for GYP(P2) allele (n = 8) and heterozygosity for GYP(NY) allele (n = 3). This study reports for the first time the molecular mechanisms responsible for the S-s- phenotype in a population of African Brazilians and provides new information about the frequency and molecular bases of the GYPB*S silent gene (7.4%) in this population.

Expression of metastasis-related genes in surgical specimens of human gastric cancer can predict disease recurrence.

It was determined whether the expression level of several genes that regulate different steps of metastasis in formalin-fixed paraffin-embedded archival specimens of human gastric cancers correlated with disease recurrence and metastasis. The steady-state mRNA expression level for epidermal growth factor receptor (EGF-R), basic fibroblast growth factor (bFGF), E-cadherin, type IV collagenase and multidrug resistance (MDR-1) were examined by a colorimetric in situ hybridisation (ISH) technique, concentrating on reactivity at the periphery of the lesions. All patients were operated on for cure. 15 cases were disease-free and 10 had disease recurrence by 4.5 years after resection of the primary tumours. The expression of EGF-R and bFGF type IV collagenase was higher and expression of E-cadherin was lower in the disease-recurrence cases than in the disease-free cases. The ratio between the expression level of collagenase type IV and E-cadherin at the periphery of the surgical specimens differed significantly between the disease-free cases and the recurrent-metastatic cases. These data show that multiparametric ISH analysis for several metastasis-related genes may allow prediction of disease recurrence of gastric cancer.

A novel rescue drug, 15-deoxyspergualin. First clinical trials for recurrent graft rejection in renal recipients.

The present multicentral clinical study performed in 6 institutes demonstrated that the novel immunosuppressive agent, 15-deoxyspergualin (DSG), is very effective on rejection. In 34 cases of rejection, 30 were treated with DSG at 40 mg/m2 (1 case), 80 mg/m2 (7 cases), 120 mg/m2 (9 cases), 180 mg/m2 (9 cases), and 220 mg/m2 (8 cases). The overall remission rate was 79% in 34 cases of rejection including accelerated, acute, and chronic rejection in different periods after transplantation. Analyzing the remission rates of early phase acute rejection occurring within 3 months after transplantation according to treatment pattern, the remission rate was 100% in 3 cases treated with DSG alone (using DSG 1 week or longer after other agents), 88% in 8 cases treated by rescue use of DSG (using DSG within 1 week after other agents), and 86% in 7 cases treated by combined use of DSG with other agents. Adverse reactions included reductions in WBC and platelets, anemia, perioral numbness, gastrointestinal troubles, and others. However all these symptoms were so mild that DSG treatment was not discontinued. Further studies are necessary on the effect of DSG, especially in acute rejection under conditions that reduce the many influences of other agents as much as possible.

Technical and biologic sources of variability in the mapping of aortic, mitral and tricuspid color flow jets.

The quantification of valvular regurgitation by 2-dimensional Doppler imaging depends on identifying and minimizing variability. Aortic, mitral and tricuspid regurgitant jet areas were measured in 50 patients with sinus rhythm or atrial fibrillation to analyze the variables of reading error, valve site, jet size, rhythm and frame rate. One technician recorded jet velocities at 1 frame/cycle at a triggered interval after the electrocardiographic R wave and at frame rates of 7.5 and 15 frames/s. Jet areas from 5 consecutive beats were measured by planimetry by 1 observer. Coefficients of variation between and among groups were compared by analysis of variance; mean values were 14 to 22%. Jets grouped less than 2.5, 2.5 to 5 and greater than 5 cm2 showed the variance of small jets exceeding that of medium and large jets. Aortic regurgitant jets were largest and had smaller variance than mitral tricuspid jets. Variability due to atrial fibrillation and the slower frame rate was marginal. Intraobserver error was 4.3% and interobserver 15.4%. Thus, reproducing jet areas carries a minimum variability of 15% or higher, depending on jet size. Valve site could not be excluded as a separate variable. Comparative quantification is best limited to 1 observer.

Usefulness of a prototype intravascular ultrasound imaging in evaluation of aortic dissection and comparison with angiographic study, transesophageal echocardiography, computed tomography, and magnetic resonance imaging.

The aim of this study was to evaluate the accuracy of information obtained with a prototype intravascular ultrasound (IVUS) system in chronic aortic dissection by comparing results with angiography, transesophageal echocardiography (TEE), computed tomography, or magnetic resonance imaging. We assigned 15 patients to IVUS imaging after they underwent angiography. The detection rate of the intimal flap was 100% in all segments of the aorta, and the detection rate of the intimal tear was 0%, 50%, 50%, and 77.8% in the ascending, arch, descending, and abdominal aorta, respectively. IVUS demonstrated 100% of the celiac and renal arteries, and 80% of the superior mesenteric arteries as well as their relation to dissection. It clarified the origin of 12 of 60 main abdominal branches (20%) which were not clear on the angiogram. It also determined the distal extent of the dissection in all cases. With regard to the size of the vessel, there was a good correlation between IVUS and computed tomographic values (r = 0.98, p < 0.01). No complications occurred in any patient. IVUS accurately demonstrated thrombus or spontaneous echo contrast in the false lumen that was confirmed with computed tomography or TEE, or both. It was especially useful in evaluating the abdominal aorta with regard to determining the size of the vessel, the extent of dissection, the relation of the branches to the false lumen, and the detection of intimal tears--important information for follow-up of patients and for planning surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of transesophageal echocardiography in detecting changes in flow dynamics responsible for malperfusion phenomena observed during surgery of aortic dissection.

Intraoperative transesophageal echocardiography (TEE) was performed in order to study the flow dynamics in the descending aorta during surgery of aortic dissection Stanford A. TEE was seen to be a sensitive and accurate method to promptly detect severe decrease in retrograde pump flow and to clarify some of the mechanisms that can result in malperfusion during cardiopulmonary bypass.

Utility of 10 MHz ultrasound catheters in the intraaortic assessment of coronary artery ostial stenoses.

Our preliminary observations show that intraaortic intravascular ultrasound using 10 MHz transducer catheters is safe and feasible in the assessment of coronary ostial lesions. This imaging modality is potentially useful in decision making regarding the choice of coronary intervention.

Usefulness of transesophageal imaging of flow convergence region in the operating room for evaluating isolated patent ductus arteriosus.

Transesophageal echocardiography (TEE) was performed in 21 patients with isolated patent ductus arteriosus (PDA) with a color Doppler flow convergence method during surgical closure of the ductus. Evaluation of PDA by TEE with the flow convergence method may provide valuable information during surgery and/or thorascopic ductus clipping.

Downhill azygos vein secondary to occlusion of the superior vena cava in Behçet's disease.

A patient with downhill azygos venous flow is reported. This reverse flow was due to an obstruction in the superior vena cava and the azygos entry due to Behçet's disease. Color flow mapping of the azygos vein, using transesophageal real-time two-dimensional Doppler echography, was used for both anatomic and hemodynamic analysis.

The value of Doppler echocardiography in the treatment of tricuspid regurgitation in patients with mitral valve replacement. Perioperative and two-year postoperative findings.

The treatment for tricuspid regurgitation in patients who have mitral valve replacement remains controversial partly because of the lack of a convenient method for measuring reflux. The purpose of this study was to assess Doppler measurement of tricuspid regurgitation in selecting patients for surgical or nonsurgical management and in evaluating the results. Thirty-three patients who had mitral valve surgery had three ultrasound examinations: before operation, before discharge from hospital, and 2 years after operation. Seventeen patients were assigned to tricuspid annuloplasty and 16 to no procedure. Assignment was based on visual grading of regurgitant velocity maps and intraoperative grading by direct palpation. Before operation patients in the annuloplasty group had larger mean jet velocity areas, right atrial size, and diastolic transvalvular velocities than had the nonsurgical group. However, the overlap of data precluded the definition of thresholds for separating the patients into either of two regimens. Early after operation the patients with annuloplasties showed decreased regurgitant indexes similar to the preoperative levels of patients who had no procedure; the latter preoperative levels had not changed. Late after operation both groups showed stabilization or trends toward less regurgitation, and continued decreases in tricuspid diastolic flow velocities. Thus Doppler ultrasonography played a complementary role in selecting patients for annuloplasty or nonsurgical management and a major role in the longitudinal evaluation of treatment.

Intraoperative color flow mapping by real-time two-dimensional Doppler echocardiography for evaluation of valvular and congenital heart disease and vascular disease.

We have developed real-time two-dimensional Doppler echocardiography, which can display color flow mapping on a two-dimensional echocardiogram. Intraoperative two-dimensional Doppler echocardiography was performed during cardiovascular operations before and after the definitive procedure in 33 patients, 14 with valvular disease, eight with congenital heart disease, and 11 with vascular disease. Its clinical usefulness was evaluated. In patients with valvular heart disease, 13 valve replacements, 10 valvuloplasties, and four untouched lesions were assessed. No paravalvular leakage and three instances of minimal physiological transvalvular leakage from St. Jude Medical valves in the mitral position were noticed. Regurgitation after valvuloplasty was graded by extent of the regurgitant flow. This grading, comparable to postoperative grading, indicated no need for an additional procedure. In congenital heart disease, preoperative diagnoses were confirmed. The effect of the corrective operation was evaluated and no significant leakage or stenosis was found. Interatrial shunt flow was shown to increase after operative balloon atrial septostomy in a patient with dextro-transposition of the great arteries. In 11 patients with dissecting aortic aneurysm, the aneurysm was totally visualized in the operative field, including the structure and flow dynamics. In two patients, the preoperative cineangiographic diagnosis regarding involvement of dissection was corrected. After the vascular procedure, sufficient flow in the major aortic branches was confirmed in all patients and minimal leakage at the suture line was noticed in four patients. In conclusion, intraoperative color flow mapping by two-dimensional Doppler echocardiography has enabled the precise diagnosis and the necessary operation to be determined before cardiopulmonary bypass. It has also allowed the effects of the operation to be assessed before chest closure.

Beneficial effect of fluorocarbon reperfusion on postoperative cardiac dysfunction of transplanted heart.

Fluosol DA 20% (Fluosol) perfusion was used to protect ischemic donor hearts of mongrel dogs from reperfusion injury. Fifteen orthotopically transplanted hearts, eight in the control group and seven in the Fluosol group, were studied for 3 hours after weaning from cardiopulmonary bypass. Donor hearts were arrested and immersed in 4 degrees C St. Thomas's Hospital Solution for 4 hours. The mean total ischemic time was 323 minutes (range, 298 to 345 minutes). In the Fluosol group, 200 ml of oxygenated Fluosol (37 degrees C; PO2 650 mm Hg; PCO2 35 mm Hg) was infused into the aortic root at approximately 100 ml/min just before aortic unclamping. Coronary sinus blood was analyzed for the MB fraction of creatine kinase, reduced glutathione, and oxidized glutathione. Hemodynamic and biochemical results were obtained at 30 minutes, 1 hour, and 3 hours after bypass. In the control group, during the second 30 minutes of the period after bypass, left ventricular end-diastolic pressure and stroke volume showed progressive deterioration, 54.8% increased (p less than 0.01) and 28.4% decreased (p less than 0.05), respectively. The MB fraction of creatine kinase and oxidized glutathione were increased, and reduced glutathione had declined, from 39.3 to 135.3 IU/L (p less than 0.01), from 28.0 to 33.4 micrograms/ml (p less than 0.05) and from 4.4 to 2.5 micrograms/ml (p less than 0.01), respectively. These parameters failed to recover during the next 2 hours, and massive mitochondrial degeneration was observed by electron microscopy. In the Fluosol group, these parameters maintained their baseline values, and electron microscopy showed well-preserved mitochondria. The data suggested that, in the control group, initial mitochondrial dysfunction was profound, persistent for at least 3 hours, and associated with membrane hyperpermeability, leading to cardiac dysfunction. Oxygenated Fluosol perfusion better preserved cardiac and mitochondrial function.

Systemic dissemination of ethanolamine oleate after injection sclerotherapy for esophageal varices.

Sclerotherapy for esophageal varices was performed on six patients for a total of 16 injections. The sclerosant contained 5% ethanolamine oleate and technetium Tc 99m sodium pertechnetate solution at the volume ratio of 9:1. At each injection session 5 to 20 mL of this solution was injected into one varix. The distribution of the injected material was observed by a scintillation camera. Systemic dissemination of the sclerosant through the portal vein was demonstrated in five procedures, in which the injections were correctly intravenous. In three dogs 4 mL of 5% ethanolamine oleate made from oleic acids labeled with iodine 131 was injected into the gastric coronary vein. Most of the substance injected was washed out within five minutes, and systemic dissemination became evident.

Redo without transfusion in a patient with idiopathic thrombocytopenic purpura.

Mitral valve replacement was able to be carried out at redo operation requiring neither allogeneic platelet nor blood transfusion in a patient with idiopathic thrombocytopenic purpura, by means of preoperative high-dose intravenous gamma-globulin, autologous blood predonation, use of a centrifugal pump, heparin-coated extracorporeal circuits, and simultaneous splenectomy.

Severe diffuse atherosclerotic lesions of right gastroepiploic artery graft.

The incidence of arteriosclerosis of the right gastroepiploic artery (RGEA) has not been widely known. We experienced one patient in whom the RGEA had severe diffuse atherosclerotic lesions and luminal narrowing, and was therefore determined to be unsuitable as a coronary bypass conduit at operation.

Left and right ventricular flows by Doppler echocardiography: serial measurements in patients with aortic regurgitation during exercise, cold pressor stimulation, and vasodilation.

To test the practicality of Doppler echocardiography to measure serial change, biventricular outputs were measured in 15 patients with aortic regurgitation during control periods and during interventions of bicycle exercise, cold pressor stimulation, and vasodilation. Biventricular stroke volumes were measured in 10 normal subjects for validation of methods and differed by 2.8%. Reading errors were 3.7%. Signal quality improved between the first and last observation (p less than 0.05). Velocity signals were corrected for intercept angles, which averaged 12 and 19 degrees for right heart flows and 31 and 32 degrees for the left side of the heart in all subjects. Negative correlations occurred between intercept angles and the chronologic order in which the patients were studied for left (p = 0.02) and right (p = 0.05) flows. Mean flow areas varied 9% in the left ventricle and 20% in the right ventricle. Total variability for measuring flow determined from control values was 11% to 13%. When twice the variability was used as the detectable level of change, only exercise provoked real increases in biventricular flows in the majority of patients. We conclude that serial measurements of flow by Doppler echocardiographic methods had to exceed 20% to 25% to achieve significant change. Measuring intercept angle, resolving flow area, and learning are variables that need greater emphasis.

Autologous blood transfusion in patients with hepatocellular carcinoma undergoing hepatectomy.

BACKGROUND: Homologous blood transfusion (HBT) has the risk of an immunosuppressive effect and may adversely affect the prognosis of patients with carcinomas. Autologous blood transfusion (ABT) has not yet become a standard procedure in gastroenteric cancer surgery. We investigated the usefulness and problems of ABT combined with the use of recombinant human erythropoietin (rh-EPO). METHODS: An evaluation of autologous blood transfusion (ABT) combined with recombinant human erythropoietin (rh-EPO) treatment was conducted in 46 patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative autologous blood donation (ABD) was accomplished for 25 of the 46 patients. The preoperative changes in hemoglobin and hematocrit in relation to route of administration of erythropoietin were studied. In addition, intraoperative blood requirements and the postoperative complications for patients who predonated were compared with those of patients who underwent surgery without autologous predonation. RESULTS: The proportion of patients not requiring additional homologous blood transfusions (HBT) during operation was significantly higher in the ABD group than in the non-ABD group (88% versus 38%). The incidence of postoperative complications was significantly higher in patients receiving HBT than in nontransfused patients and in those receiving ABT. CONCLUSIONS: Preoperative autologous blood donation in combination with rh-EPO therapy markedly reduced the requirement for homologous blood transfusion during surgery in patients with hepatocellular carcinoma having hepatectomy.

Endoscopic harvest of saphenous vein graft for coronary artery bypass grafting: Saitama-Olympus technique.

OBJECTIVE: This study was undertaken to examine the clinical feasibility of a newly developed video-assisted endoscopic technique (Saitama-Olympus technique) to harvest saphenous vein graft (SVG) in 40 CABG patients. METHODS: There were 37 males and three females with an average age of 59+/-11 years. The special instruments developed were optical sheath, solid dilators, tunnel retractor, vessel dissector, GCC forceps which were utilized in conjunction with the thoracoscopic surgery system (Olympus, Tokyo, Japan). The course of the saphenous vein (SV) was marked on the skin prior to operation. SV was identified in the femoral region with a 4-cm skin incision and dissected with an open technique. The anterior surface of SV was dissected for 30 cm by the optical sheath mounted on the endoscope. Then another 4-cm skin incision above SV was placed in the popliteal region, resulting in a subcutaneous space over the SV. The subcutaneous space was then dilated and maintained with the tunnel retractor which has an endoscope channel at the top. With this system SV was visualized stably by endoscope without any assistance. All side branches were dissected and divided with the vessel dissector. When longer SVG is required, the same procedure was extended to the ankle with additional one or two skin incisions. RESULTS: SV was easily harvested in all patients with spending 15-84 min. The average number of skin incisions was 2.4+/-0.5 and the average length of the harvested SVG was 41+/-12 cm. The average number of bypassed grafts was 3.4+/-1.0 with use of left internal mammary artery (IMA) in 31 patients. The average operation time was 272+/-52 min, there were no significant prolongation relating to endoscopic SVG harvesting. The remainder of SVG in each patients was pathologically examined and there were no evidence of intimal injury. There were no major wound complications during the average follow-up of 10+/-4 months and this technique seemed to be advantageous for patients with less wound pain and better cosmetic appearance. CONCLUSIONS: The Saitama-Olympus technique to endoscopically harvest the SV is a clinically feasible surgical technique with the unique potential of a significant reduction in morbidity and decreased wound scarring in CABG patients.

A new technique in echocardiology: B-mode to M-mode transformation.

In conventional two-dimensional Echocardiography with sector scanning, M-mode is simultaneously displayed on TV-monitor as the time based ultrasound signals. With conventional system, one end of the cursor-line in B-mode image which indicates the beam direction of M-mode, is always fixed at the point corresponding to the transducer tip. This system has the capability to transform B-mode to M-mode images in any desired direction. However, the time resolution in M-mode is limited to about 33 milli-seconds.

[Radiological changes following mammoplasty (author's transl)]. / Die röntgenologischen Veränderungen nach Mammaplastik.

We describe the radiological changes in 16 female patients following mammoplasty and demonstrate that calcification and solitary dense shadows are a cause of difficulty in the differential diagnosis of carcinomas.