[Evaluation of early results of re-coronary artery bypass grafting].

Redo surgery is more difficult than primary operation. From January 2002 to December 2008, 19 patients underwent re-coronary artery bypass grafting (re-CABG) [6.4 percent of the total CABG] : CABG (16) and CABG + combined procedure (3). Approach of redo operation consists of, median re-sternotomy (5), left posterolatelal thoracotomy (4), via diaphragm (6) and left anterior small thoracotomy (LAST) [1]. In a redo operation, we consider different approaches from the primary operation to avoid injury during dissection of adhesive tissue. Particularly in simple CABG, 11 of the 16 patients (68.8%) were operated on adopting a different approach from the primary operation. The femoral artery and vein were exposed before median re-sternotomy. There was no serious adverse event nor operative death, and all grafts were well patent. Redo CABG can be performed with a low risk.

Clonal relationship between infiltrating immunoglobulin G4 (IgG4)-positive plasma cells in lacrimal glands and circulating IgG4-positive lymphocytes in Mikulicz's disease.

Mikulicz's disease (MD) is gaining acceptance as an immunoglobulin G4 (IgG4)-related disease characterized by bilateral lacrimal and salivary gland swelling. The aetiology of MD and other IgG4-related diseases is still unclear. The present work was performed to study the clonality of infiltrating IgG4-positive plasma cells in lacrimal glands and circulating peripheral blood cells in patients with MD, and compare the clonal relationship between infiltrating and circulating IgG4 positive cells. Total cellular RNA was extracted from the lacrimal glands and peripheral blood in five MD patients. Reverse transcription polymerase chain reaction was performed with primers specific for activation-induced cytidine deaminase (AID) and for Ig VH and IgG4. Sequences of Ig VH were compared with the structure of Ig VH of the lacrimal glands and the peripheral blood cells. AID was expressed to varying degrees in lacrimal glands of all MD patients. Most IgG4-positive cells infiltrating lacrimal glands and in peripheral blood were polyclonal, although several clonally related pairs were detected. In one patient, two of the circulating IgG4 VH4-59 clones shared identical CDR3 sequences with the clones within the lacrimal glands. In conclusion, while most tissue-infiltrating and circulating IgG4-positive cells in MD are polyclonal, some clonally related IgG4 positive cells exist between lacrimal gland and peripheral blood, accounting for the clinical features of MD as an IgG4-related disease involving multiple organs.

[Treatment of massive endobronchial hemorrhage after cardiopulmonary bypass by selective coil embolization of the bronchial artery].

A 68-year-old woman underwent aortic valve replacement to treat her aortic regurgitation. The operation was performed successfully. Just before coming off cardiopulmonary bypass, massive hemorrhage occurred through the endotracheal tube. Fiberoptic bronchoscopy could not find the bleeding site and 1,350 ml of blood had been lost. Bronchial angiography under percutaneous cardiopulmonary bypass revealed the right middle branch to be the bleeding site. The endotrachial bleeding was treated successfully by selective coil embolization of the bronchial artery. No further bronchial bleeding occurred. Although we found the bleeding site, we could not identify the cause of hemorrhage.

Intraocular lymphoma metastasis from larynx.

PURPOSE: To present a rare case of primary larynx diffuse large B cell lymphoma non-Hodgkin's lymphoma (NHL), disseminated to the cerebellum and the intraocular tissue. METHODS: A 69-year-old man noticed blurred vision in both eyes. The vitreous contained infiltrating cells bilaterally, and floating opacities were increased. We performed vitrectomy to recover the vision and diagnose for both eyes. RESULTS: The authors discovered diffuse large B cell NHL with cytopathologic examination from vitreous specimen in this case, which was identical with diffuse large B cell NHL of the larynx and cerebellum, and therefore could diagnose the intraocular lesion as the metastasis of NHL. Although the vision improved, the patient had remarkable visual disturbance in both eyes at 6 months after surgery because of the chorioretinal lesion. The authors treated by the combined curative chemotherapy and radiotherapy to ocular tissue, since providing sufficient evidence that the chorioretinal lesion was to predict the metastasis of diffuse large B cell NHL After those treatments, chorioretinal lesions have disappeared in both eyes and the vision has recovered. CONCLUSIONS: Increased attention to the possibility of dissemination of laryngeal NHL to the intraocular tissue is needed.

Inwardly rectifying K+ currents in isolated human retinal pigment epithelial cells.

PURPOSE: K+ channels in the retinal pigment epithelium (RPE) play a number of important roles, including the establishment of membrane potential, the transport of K+ between the subretinal space and choroid, and the generation of the c-wave of the electroretinogram. Previous studies on amphibian RPE demonstrated that these functions are likely served by an inwardly rectifying K+ channel. The aim of this study was to characterize inwardly rectifying K+ channels in cultured and freshly isolated adult human RPE (hRPE) cells. METHODS: Single cells were dispersed enzymatically from primary cultures of adult hRPE or from fresh adult hRPE-choroid. Ionic currents were recorded using either the perforated-patch or whole-cell configuration of the patch-clamp technique. RESULTS: In 5 mM external K+, roughly 20% of cultured hRPE cells exhibited a strong inwardly rectifying K+ conductance that passed inward but little outward current. This conductance increased when [K+]o was increased and exhibited a voltage-dependent block by external Na+ at negative potentials. In contrast, all freshly isolated hRPE cells exhibited a mild inwardly rectifying K+ conductance that mediated substantial outward current at physiological voltages. This conductance decreased when [K+]o was increased and showed no voltage-dependent block by external Na+. CONCLUSION: The authors conclude that fresh hRPE cells express a mild inwardly rectifying K+ conductance. The operation of this conductance at physiological voltages makes it a likely candidate for the resting K+ conductances of the apical and basolateral membranes. Cultured hRPE cells express a functionally different channel type that may reflect a change in phenotype.

Two types of K+ currents modulated by arachidonic acid in bovine corneal epithelial cells.

PURPOSE: Fenamate sensitivity of the large-conductance K+ current in the corneal epithelium suggests that K+ transport could be modulated by arachidonic acid (AA) and/or its metabolites, which also regulate corneal epithelial migration. The main purpose of this study was to investigate AA-induced modulation of K+ currents expressed in the bovine corneal epithelium. METHODS: Freshly isolated bovine corneal epithelial cells were perfused with Ringer solution. Whole-cell currents were recorded by using either the conventional whole-cell-patch or the perforated-patch configuration. RESULTS: Two distinct types of K+ currents dominated the whole-cell current. The first was a voltage-gated K+ current that was inactivated completely by membrane depolarization. The inactivating voltage-gated K+ current was largest in presumptive basal cells. The second was a noisy, sustained K+ current that was never inactivated and seemed to be a counterpart of the large-conductance K+ current reported in the rabbit corneal epithelium. External application of AA (5-20 microm) inhibited the inactivating voltage-gated K+ current and augmented the noisy, sustained K+ current. Identical dual modulation was induced by other fatty acids (e.g., palmitoleic acid) that are not substrates for enzymes in the AA cascade. CONCLUSIONS: An inactivating voltage-gated K+ channel was identified for the first time in the corneal epithelium. AA and some fatty acids may directly activate the large-conductance K+ channel to augment its housekeeping functions in corneal epithelial cells.

[Alteration of frog in vitro electroretinographic c-wave in modified extracellular cation concentration].

Effects of extracellular cation (Ca2+, Mg2+, Na+) concentrations on the electroretinographic c-wave were studied in the isolated neural retina-retinal pigment epithelium-choroid tissue of the bullfrog. Among the conditions studied (Ca2+, 0.5-5.0 mM: Mg2+, 0.5-5.0 mM: Na2+, 89.0-109.0 mM), only Ca2+ concentration significantly affected the c-wave. Between 1.0 mM and 5.0 mM Ca2+, the amplitude and the rise time (interval from the light onset to 90% amplitude) of the c-wave were positively and reversely correlated to Ca2+ concentration, respectively. The present results suggest that Ca2+ is one of the major determinants in the extracellular milieu on the c-wave, which is presumably due to its effects on the photoreceptoral activities.

[Effects of extracellular K+ concentration on the ERG c-wave].

The effects of K+ concentration in the perfusate on ERG were examined in bullfrog neural retina-retinal pigment epithelium-choroid preparations. In the range of K+ concentration between 1.0 and 6.0 mM, an increase in K+ concentration caused a decline in the b-wave amplitude, while leaving the b-wave peak latency almost unchanged. An increase in K+ concentration in the range between 1.0 and 3.0 mM enhanced the c-wave amplitude, while an increase in K+ concentration in the range between 4.0 and 6.0 mM diminished it. An increase in K+ concentration tended to shorten the time course of the c-wave. These results suggest that variations in the K+ concentration in tissue fluid may partially account for the marked inter- and intra-individual variations of the c-wave.

[An examination of congruency hypothesis in hopelessness theory of depression].

A longitudinal study was conducted to test two hypotheses, congruency and hopelessness-mediation, in hopelessness theory of depression. Three cognitive diatheses (attributional style, and inferential styles for consequences as well as the self), symptoms of depression, and hopelessness were measured in a survey of 279 men and women. About three months later, symptoms and hopelessness were measured again, along with negative life events in the interim. Some support was obtained for congruency hypothesis. Women with depressogenic attributional style in interpersonal domain became depressed when they experienced negative events in the domain, while men with depressogenic attributional style in achievement domain similarly became depressed. However, no comparable effect was found for the other diatheses: inferential styles. Hopelessness-mediation hypothesis was partly supported in interpersonal domain.

[A case of cardiac myxoma associated with congenital oculocutaneous albinism].

This case is a 43 year-old-woman of left atrial myxoma associated with oculocutaneous albinism, who was admitted to our hospital because of nocturnal cough everyday. Electrocardiogram showed normal sinus rhythm and complete right bundle branch block. Chest X-ray disclosed slight enlargement of left atrium. Echocardiography revealed the left atrial pedunculated tumor, arising from atrial septum, prolapsing into left ventricle during diastole, which was coincided with lucent tumor by levophase of pulmonary arteriography. Feeder artery of this tumor was visualized by right coronary arteriography. Cardiac catheterization represented normal pressure of right-sided heart. Thus the diagnosis of left atrial myxoma was established. At the operation, radical excision of the base of tumor and septum and patch closure was undergone. The gross morphology and microscopic findings were consistent with myxoma.

[Clinical study of serum enzyme and metabolic changes after extracorporeal circulation--comparison with the surgery of aortic aneurysm].

The changes of serum enzyme and metabolism were studied by comparing the serial change among three groups. The first group consisted of twenty seven patients treated by surgery under extracorporeal circulation. The second group of ten patients of thoracic aortic aneurysm treated under temporary bypass and the third group of nineteen patients of abdominal aortic aneurysm under aortic cross clamp. The following results were obtained: The enzyme of serum GOT, LDH and CPK increased postoperatively in the all groups, the changes after surgery being greater in the group 1 than the other groups. The metabolism of lactic acid and glycolipid was depressed in the group 1 higher than the other groups. The tissue injury of total body after surgery with extracorporeal circulation was greater than the other groups without extracorporeal circulation. And these results suggest the necessary of improvement of circuit and perfusion technique of extracorporeal circulation.

Isolated bovine retinal pigment epithelial cells express delayed rectifier type and M-type K+ currents.

Outwardly rectifying K+ currents in freshly isolated bovine retinal pigment epithelial (RPE) cells were characterized using the whole cell and perforated-patch configurations of the patch-clamp technique. All cells exhibited a delayed rectifier type K+ current. This current had an activation threshold voltage of approximately -40 mV, activated with a sigmoidal trajectory, and inactivated completely over a period of several seconds. External tetraethylammonium (TEA) was an effective blocker of the delayed rectifier current [apparent dissociation constant (Kd) = 5.1 mM], but external Ba2+ was relatively ineffective. Approximately 24% of the cells also exhibited a sustained outwardly rectifying K+ current that became activated at voltages positive to approximately -80 mV. This current resembled the neuronal M-current. External Ba2+ was a potent blocker of this current (apparent Kd = 1.1 mM), but external TEA and Cs+ were relatively ineffective. These results indicate that freshly isolated bovine RPE cells express K+ currents of both the delayed rectifier and M types. The latter may contribute to the resting K+ conductances of the apical and basolateral membranes.

ATP-dependent regulation of inwardly rectifying K+ current in bovine retinal pigment epithelial cells.

Inwardly rectifying K+ current (IKir) in freshly isolated bovine retinal pigment epithelial (RPE) cells was studied in the whole cell recording configuration of the patch-clamp technique. When cells were dialyzed with pipette solution containing no ATP, IKir ran down completely in <10 min [half time (t1/2) = 1.9 min]. In contrast, dialysis with 2 mM ATP sustained IKir for 10 min or more. Rundown was also prevented with 4 mM GTP or ADP. When 0.5 mM ATP was used, IKir ran down by approximately 71%. Mg2+ was a critical cofactor because rundown occurred when the pipette solution contained 4 mM ATP but no Mg2+ (t1/2 = 1.8 min). IKir also ran down when the pipette solution contained 4 mM Mg2+ + 4 mM 5'-adenylylimidodiphosphate (t1/2 = 2.7 min) or 4 mM adenosine 5'-O-(3-thiotriphosphate) (t1/2 = 1.9 min), nonhydrolyzable and poorly hydrolyzable ATP analogs, respectively. We conclude that the sustained activity of IKir in bovine RPE requires intracellular MgATP and that the underlying mechanism may involve ATP hydrolysis.

An outwardly rectifying K+ current active near resting potential in human retinal pigment epithelial cells.

Currents in freshly dissociated adult human retinal pigment epithelial (RPE) cells were studied using the perforated patch-clamp technique. The zero-current potential (V0) averaged -48.9 +/- 7.7 mV (n = 50). Depolarizing voltage pulses from -70 mV evoked an outward current that activated with first-order kinetics and that did not inactivate during prolonged depolarizations. Repolarizing the membrane potential produced tail currents that reversed near the K+ equilibrium potential, indicating that the sustained outward current was carried mainly by K+. The outwardly rectifying K+ conductance (gK) had an activation threshold voltage near -60 mV and was half-maximal at -37 mV. Approximately 25% of gK was active at the average V0. The K+ current was nearly completely blocked by 2 mM Ba2+ but was relatively insensitive to 20 mM tetraethylammonium. The kinetics, voltage dependence, and blocker sensitivity of this current clearly distinguish it from delayed rectifier K+ currents previously identified in RPE cells. We conclude that the sustained outward K+ current may help establish the resting potential of the apical and/or basolateral membranes and may also participate in K+ transport across the RPE.

Vasoactive effects of cimicifugic acids C and D, and fukinolic acid in cimicifuga rhizome.

Vasoactive effects of cimicifugic acids A-E, fukinolic acid and fukiic acid isolated from Cimicifuga plants were investigated using rat aortic strips. Cimicifugic acid D and fukinolic acid at 3x10(-4) M caused a sustained, slowly developing relaxation of aortic strips precontracted with norepinephrine (NE) in preparations with or without endothelium. Cimicifugic acid C inversely caused a weak contraction. Cimicifugic acids A, B and E and fukiic acid showed no vasoactivity at 3x10(-4) M. Cimicifugic acids A-E and fukinolic acid are esters between cinnamic acids and the hydroxyl group of benzyltartaric acids. For the manifestation of vasoactivity in the rat aorta, it is concluded that in the cinnamic acid moiety, a caffeoyl group might be necessary for the relaxation activity, and the p-coumaroyl group causes contraction. Concentration response curves for the Ca2+-induced contracture of depolarized aortic strips with isotonic high K+ were not affected by cimicifugic acid D or fukinolic acid. The Ca2+-induced contraction of aortic strips, preincubated with 10(-6) M NE in the presence of 10(-6) M nicardipine and 0.01 mM EGTA in Ca2+-free solution, were inhibited by cimicifugic acid D and fukinolic acid. These results indicated that the inhibition by cimicifugic acid D and fukinolic acid of the NE-induced contraction of rat aorta are attributable to the suppression of Ca2+ influx from the extracellular space enhanced by NE.

Studies on inhibitory activities of fukiic acid esters on germination, alpha-amylase and carboxypeptidase A.

Fukinolic acid (1) and cimicifugic acid A (2), caffeic acid analogs, as well as rosmarinic acid (3) and caffeic acid (4) showed inhibition on seed germination and seedling growth. The potency of 1 and 2 was comparable with that of 3. Compounds 1 and 2 also showed strong inhibitory activities as well as 3 and 4 on alpha-amylase. The activity of 1 was higher than that of acarbose used as a positive control, and its 50% inhibitory concentration (IC50) was 2.41 x 10(-5) M. Compounds 1 and 2 also showed inhibitory activities strong as 3 and stronger than 4 on carboxypeptidase A. The activities of 1 and 2 were higher than that of 1, 10-phenanthroline used as a positive control.

Antimalarial activity and nucleoside transport inhibitory activity of the triterpenic constituents of Cimicifuga spp.

The in vitro antimalarial activity against human malaria parasite (Plasmodium falciparum, FCR-3 strain) was examined using 59 triterpenoids obtained during studies on the triterpenic constituents of Cimicifuga spp. The 50% effective concentration values (EC50) of 25 active triterpenoids were 1.0-3.0 microM, and 19 of the compounds had a common 16, 23:23, 26:24, 25-triepoxy group in the side-chain moieties. Among the active triterpenoids, 9 also showed significant inhibition of nucleoside transport in mouse splenocytes. A relationship between the antimalarial activity and the inhibition of nucleoside transport involving these triterpenoids is discussed.

Upregulation of retinal vascular endothelial growth factor mRNAs in spontaneously diabetic rats without ophthalmoscopic retinopathy. A possible participation of advanced glycation end products in the development of the early phase of diabetic retinopathy.

Vascular endothelial growth factor (VEGF) has recently been shown to be involved in the pathogenesis of proliferative diabetic retinopathy. However, its involvement in the development of the early phase of diabetic retinopathy is not fully understood. In this study we investigated the retinal VEGF mRNA level in spontaneously diabetic Otsuka Long-Evans Tokushima fatty (OLETF) rats, a model of non-insulin-dependent diabetes, without overt retinopathy, using quantitative reverse-transcription polymerase chain reaction. The retinal VEGF mRNA level was 2.2 times higher (p < 0.0005) in OLETF rats than in control rats at the age of 60 weeks. Moreover, their retinal mRNA level was positively correlated with serum concentration of advanced glycation end products (AGEs) but not to serum glucose concentration. Furthermore, the peak latency of the oscillatory potentials in the electroretinogram, one of the most sensitive markers for the early phase of diabetic retinopathy, was significantly prolonged in OLETF rats (p < 0.05), being also correlated with the serum AGE concentration. The results thus suggest that AGEs, which are formed acceleratedly in diabetic conditions, are involved in the development of the early phase of diabetic retinopathy probably through the induction of retinal VEGF mRNAs.