[Successful surgical treatment of acute pulmonary thromboembolism caused by giant intra-pervic tumor; report of a case].

A 40-year-old woman was admitted to our hospital because of operation for giant intra-pervic tumor. She had a history of deep vein thrombosis. Suddenly she complained severe dyspnea while having a bath, and subsequently cardiogenic shock occurred. Immediately we set up percutaneous cardiopulmonary support (PCPS) for acute pulmonary thromboembolism. Despite thrombolytic therapy including the administration of urokinase and rt-PA, hemodinamics were not improved. Emergent pulmonary embolectomy was performed on-pump beating. Postoperative course was uneventful. The intra-pervic tumor was removed on the 24th postoperative day. She was discharged in good condition on the 38th postoperative day. Quick diagnosis and appropriate therapy are essential in patient with acute massive pulmonary thromboembolism.

[Recurrent pulmonary embolism with prolonged right heart failure and hypoxia after cerebral bleeding; report of a case].

A 56-year-old woman with right hemiplegia for recent cerebral bleeding suddenly complained of dyspnea and chest pain with hypoxia during rehabilitation. Eight days after this first attack, she suffered prolonged right heart failure and hypoxia due to recurrent pulmonary embolism. Arterial blood gas analysis of room air showed 34.5 mmHg of PaO2 and 29.2 mmHg of PaCO2. Echocardiography showed enlargement of the right atrium and ventricle with pulmonary hypertension. Enhanced chest computed tomography revealed pulmonary emboli from the main pulmonary artery to the periphery. Despite intensive treatment, heart failure and hypoxia did not improve. We conducted pulmonary embolectomy under cardiopulmonary bypass requiring percutaneous cardiopulmonary bypass support for 2 days due to right heart failure. She is currently doing well in the 9 months following surgery.

[Total aortic arch replacement for distal aortic arch aneurysm with adhered left lung: report of a case].

A 76-year-old man with a history of pleuritis and a cerebral infarct underwent a total arch replacement for an aneurysm of the distal aortic arch. Computed tomography revealed a true aneurysm having a maximum diameter of 70 mm as well as pleural thickening and calcification. Total arch replacement with selective cerebral perfusion was performed through median sternotomy and left thoracotomy. The myocardial ischemic time was shortened by reperfusion from the right axillary artery after the anastomosis of the proximal ascending aorta and the brachiocephalic artery. After the other branches of the arch were anastomosed, a distal anastomosis through the left thoracotomy was then performed using the pull-through method, enabling minimal decortication of the adhered lung. Our surgical procedure for distal arch aneurysm with adhered lung involves the addition of a left thoracotomy, but the reduction in the myocardial ischemic time and lung injury are of benefit.

[Intravenous leiomyomatosis with cardiac extension in an elderly woman: report of a case].

Intravenous leiomyomatosis is a histologically benign smooth-muscle tumor arising from either a uterine myoma or the wall of a uterine vessel with extension into veins. We describe a 71-year-old woman with a prior history of subtotal hysterectomy for uterine myoma years earlier who presented with palpitation. Echocardiographic examination revealed an intracardiac mass protruding into the right ventricle during diastole. The caval tumor could be traced to the right renal vein by magnetic resonance image. She was operated on for intracardiac and intracaval leiomyomatosis. The intracaval tumor proved to be not totally resectable. Presence of smooth muscle was confirmed by smooth muscle actin and desmin positive cells in the tumor. Tumor cells also proved to possess estrogen receptors. The patient has been closely followed-up with antiestrogen therapy.

A study of the intestinal absorption of an ester-type prodrug, ME3229, in rats: active efflux transport as a cause of poor bioavailability of the active drug.

The intestinal absorption of a prodrug is affected by a number of factors, such as its membrane permeability, stability in the gut lumen, and conversion to the parent drug in enterocytes. We evaluated the absorption of ME3229, an ester-type prodrug of a hydrophilic glycoprotein IIb/IIIa antagonist. Although the octanol/water distribution coefficient and permeability across a Caco-2 cell monolayer of ME3229 was high enough for us to expect good oral absorption, less than 10% of the dose was absorbed in rats. To clarify this unexpected outcome, we evaluated the rate of its disappearance from the gut lumen (V1), its degradation in the gut lumen (V(deg)), uptake into enterocytes (V(uptake)), and appearance in the mesenteric vein (V2) by using a single-pass perfusion technique in combination with an in vitro metabolism study. Our data suggested that ME3229 crossed the apical membrane and was taken up into enterocytes at a rate compatible with its lipophilicity, but that only a small fraction of the metabolites formed in enterocytes reached the mesenteric vein, primarily attributable to efflux into the intestinal lumen. Transport of the main metabolite across rat intestinal tissue mounted on an Ussing chamber suggested that an active efflux system pumped out any ionic metabolite(s) present.

[Cardiac tamponade due to ruptured intramural hematoma of the ascending aorta: a case report].

A 72-year-old man with a history of hypertension for 20 years was admitted with symptoms of acute aortic dissection. Computed tomography showed a crescentic thickening of the ascending aortic wall, suggesting an intramural hematoma. Sixteen hours after admission, he underwent urgent repair of the ascending aorta because of cardiac tamponade. We inspected the inside of the aorta from the aortic valve to the arch. Subadventitial hematoma due to hemorrhage from the outer media was confirmed. Rupture of the vasa vasorum was thought to be an initiating mechanism. The affected aortic wall was simply resutured and was not replaced with a graft because the intima was intact and the media was not dissected and the aortic wall was considered to be tolerable to normal blood pressure. The patient continues to do well 18 months following operation. An intramural hematoma of the ascending aorta should be regarded as a precursor of imminent rupture or classic dissection.

Bilateral endobronchial metastasis in postoperative stage I pulmonary adenocarcinoma.

We reported a case of bilateral endobronchial metastasis in postoperative synchronous adenocarcinoma. Twenty months ago, a 63-year-old man underwent combined operation. Biopsy was performed, histological diagnosis of pulmonary adenocarcinoma. When surgery is not indicated because the patient has decreased pulmonary function and contralateral metastatic lesions, the Nd-YAG laser has been used to treat focal malignancy of the trachea and mainstem bronchi, and the laser has been effective, especially in patients with inoperable lesions.

[The use of the Wallstent prosthesis in the treatment of superior vena cava syndrome].

Five patients (4 men and one woman) aged 48-82 years who were suffering from superior vena cava (SVC) syndrome had Wallstent implanted percutaneously to relieve the obstruction. After stent placement, all cases received anticoagulant therapy with heparin. However one transient stent thrombosis occurred, stent placement resulted in complete relief of all patients. Wallstent placement could be an extremely useful treatment for SVC syndrome and should be the treatment of choice in all cases where SVC obstruction occurs or recurs, following chemotherapy or radiotherapy.

Simplified rapid non-radioactive PCR-SSCP method applied to K-ras mutation analysis.

A newly modified non-RI, PCR-SSCP method is presented and applied to K-ras analysis of colorectal tumors. It comprises five steps: (1) sampling of tiny pieces of fresh solid tissue by scraping with disposable bamboo combs (thin bars made of bamboo, 3 x 3 x 120 mm in size); (2) one-step DNA extraction with lysis buffer containing proteinase K, Nonidet P-40 and Tween 20; (3) PCR with 108 bp, c-ki-ras 2 gene primers; (4) SSCP analysis with 10% formamide-added polyacrylamide gels; and (5) detection with silver staining. In comparison with conventional RI- or non-RI-PCR-SSCP, It can give reliable and clear results in a much shorter time (within a total of 6 h). This novel approach should allow more frequent use of molecular diagnosis in biopsies and surgical pathology.

Mutagenicity study of the new cephalosporin antibiotic cefditoren pivoxil.

The mutagenicity of a cephalosporin antibiotic, (-)-(6R,7R)-2,2-dimethylpropionyloxymethyl 7-[(Z)-2-(2-aminothiazol-4-yl)-2-methoxyiminoacetamido]-3-[(Z)-2- (4-methylthiazol-5-yl) ethenyl]-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylate (cefditoren pivoxil, CAS 117467-28-4, CDTR-PI), was evaluated by various mutagenicity tests as follows: the reverse mutation assay in bacteria, the chromosomal aberration test with Chinese hamster CHL cells, the micronucleus test with mice, the hypoxanthine-guanine phosphoribosyl transferase (HGPRT) locus gene mutation test with L5178Y cells, the chromosomal aberration test with human lymphocytes, the unscheduled DNA synthesis test with rat stomach mucosa cells, and the cell transformation test with BALB/3T3 cells. CDTR-PI induced the structural chromosomal aberrations considered direct action in the chromosomal aberration test with CHL cells at concentrations of 150 micrograms/ml and more, but in none of the other mutagenicity tests even in excessive doses. Evaluation for clastogenicity with metabolites of CDTR-PI and checking for formaldehyde generation in the culture medium appeared to verify that the original source of the clastogenicity of this antibiotic was a formaldehyde generated from a pivoxil radical of CDTR-PI. The carcinogenicity of formaldehyde has been reported as negative in rats administered orally for 2 years. These results suggested the CDTR-PI would reveal neither mutagenicity nor carcinogenicity under clinical conditions.

[Right ventricular myxoma with near obstruction of the pulmonary artery].

Right ventricular myxoma is very rare. To our knowledge, only 23 cases in Japan have been reported in the literature. A 76-year-old male was admitted with complaints of cough and dyspnea. We found an abnormal floating mass in the right ventricular outflow tract by echocardiography and cineangiocardiography. The digital subtraction angiography showed that the following mass continuously lodged in the pulmonary artery with total occlusion of the left main pulmonary artery and near obstruction of the right pulmonary artery. Furthermore he had the constitutional signs of myxoma and the serum IL-6 level reached 41.7 pg/ml. Under extra-corporeal circulation, we salvaged the right ventricular outflow tract to the right lung, resecting the tumor, originated from the right ventricular septum and extended to bilateral main pulmonary arteries.

[A successful transatrial repair of post-infarction ventricular septal defect].

A 63-year-male underwent successful operation for the ventricular septal perforation (VSP) caused by the inferior myocardial infarction. As the condition was stable, an operation was performed at the 43rd day after onset of myocardial infarction. Exposure was obtained by the opening the right atrium and retracting the tricuspid valve. The defect was in the posterior portion of the ventricular septum and closed using a Dacron patch. His postoperative course was uneventful. Postoperative examinations show no residual shunt. We believe that this approach may offer reduced mortality and morbidity in a selected group of patients with acquired posterior VSP, by avoiding such complications as further trauma to the ventricle, hemorrhage, and arrhythmias.

[Comparative study of anticoagulant management after coronary artery bypass surgery--warfarin versus dipyridamole].

A prospective randomized study was performed in 137 coronary artery bypass surgery cases to determine if the administration of antiplatelet drugs would improve the patency of coronary artery bypass grafts. The warfarin group received warfarin and thrombotest was controlled to 20% or so. The dipyridamole group received both 300 mg of dipyridamole and 250 mg of aspirin orally each day. These two groups were compared for study in grafts patency. Results were analyzed by chi-square. In the warfarin group, 66 patients had three ITA-LAD grafts and 115 saphenous vein grafts (including 4 sequential grafts). In the dipyridamole group, 71 patients underwent 38 ITA grafts and 167 saphenous vein grafts (including 56 sequential grafts). Eighty-eight of the 107 grafts (82%) were patent in the warfarin group, and 190 of 205 grafts (95%) were patent in the dipyridamole group (p less than 0.01). Of the two ITA grafts in the warfarin group, no graft was occluded, a patency of 100%. In the dipyridamole group, 35 of 38 ITA grafts (92%) were patent. In the warfarin group, 86 of 105 saphenous vein grafts (82%) were patent. In the dipyridamole group, 155 of 167 saphenous vein grafts (95%) were patent (p less than 0.01). In the study of grafted coronary vessel, the patency of left anterior descending coronary artery, diagonal branch and right coronary artery was not significant between two groups. In the dipyridamole group, the patency of left circumflex coronary artery was 93%, and that of the warfarin group was 50% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Dual focal point electro-optic lens with a Fresnel-zone plate on a PLZT ceramic.

A new dual focal point electro-optic lens that is switchable to focusing and unfocusing is proposed and successfully demonstrated. This electro-optic lens is constructed by coating transparent fine electrodes in the Fresnel-zone plate onto a PLZT ceramic plate. Its focal length changes from 1.25 m to infinity binary at 515 nm with the external voltage of 210 V.

New polyphenolic 5'-nucleotidase inhibitors isolated from the wine grape "Koshu" and their biological effects.

New 5'-nucleotidase inhibitors designated as NPF-88BU-IA, NPF-88BU-IB, NPF-88BU-IIA and NPF-88BU-IIB, respectively, were isolated from the seeds and skin of the wine grape "Koshu". They were purified by solvent extraction, dialysis, and reversed-phase high performance liquid chromatography (HPLC). Their physico-chemical properties revealed these compounds to be polyphenolic substances. The average relative molecular masses of the four were estimated by gel permeation chromatography (GPC) analysis to be 7850, 5950, 11900, and 11300, respectively. They strongly inhibited 5'-nucleotidase activities from snake venom and rat liver membrane, and displayed significant therapeutic activity against Ehrlich ascites carcinoma. They also showed inhibitory effects on the growth of Streptococcus mutans MT8148(c), a primary cariogenic bacterium. Furthermore, these 5'-nucleotidase inhibitors inhibited the glucan formation from sucrose. These results suggest that the 5'-nucleotidase inhibitors can prevent the cause of caries of tooth.

The growth inhibition of Streptococcus mutans by 5'-nucleotidase inhibitors from Areca catechu L.

New 5'-nucleotidase inhibitors named NF-86I, NF-86II were recently isolated from the seeds of Areca catechu L. NF-86I and NF86II showed inhibitory effects on the growth of Streptococcus mutans MT8148(c) and Streptococcus mutans MT6715(g), respectively. In addition, these inhibitors could inhibit insoluble glucan formation from sucrose. NF-86I and NF-86II were found to be polyphenolic substances. Some polyphenols such as tannic acid bind non-specifically to proteins (tannic activity). The 5'-nucleotidase inhibitors that we isolated did not show any such activity. However, the growth inhibitory activity and the inhibitory effect on water-insoluble glucan production were equal to tannic acid. It is therefore considered that these inhibitors bind specifically to the bacterial cell surface. Our findings suggest that the 5'-nucleotidase inhibitors NF-86I and NF-86II may be useful anti-plaque preventing agents.

Electro-optic variable focal-length lens using PLZT ceramic.

Proposed is an electro-optic (E-O) variable focal-length lens by combining EO material with numerous transparent fine electrodes on its surface. Coating indium tin oxide transparent electrodes on a lanthanum-modified lead zirconate titanate (9/65/35) ceramic plate and introducing a parabolic index profile with dc voltage, we successfully demonstrate a positive EO variable focal-length lens, obtaining its focal length from infinity to 1 m with applied voltage up to 300 V to an electrode gap of 50 microm. Theoretical analysis is also given, together with a discussion for improving aberration and resolving power.