Combined aortic and mitral valve repair in active infective endocarditis

We describe a case of successful combined repair of the aortic and mitral valves for an indication of active infective endocarditis involving both valves. Mitral valve repair was achieved by vegetation debridement, fixation of the anterior mitral commissure, resection and suturing of the posterior mitral leaflet, and posterior annuloplasty with autologous pericardium. Aortic valve repair was achieved by vegetectomy and commissural plication. Postoperative clinical course was without signs of recurrent infection, and echocardiogram demonstrated mitral valve competence with trivial aortic regurgitation. We concluded that simultaneous valve repair is a viable option in the context of active endocarditis.     

Virulent influenza A viruses induce apoptosis in chickens

Virulent avian influenza A viruses produce lethal disease in chickens. Since cell death can be caused by either necrosis or apoptosis, we investigated the types of cell death that occur in natural hosts, chickens, infected with virulent avian viruses. Using biochemical methods, we demonstrate that virulent avian influenza viruses induce apoptosis of vascular endothelial cells in liver, kidney, and brain. Viral antigens were also detected in these organs, suggesting that viral replication induces apoptosis in infected chickens. These results indicate that apoptosis does occur in virulent avian influenza virus infection in a natural host, and may contribute to the lethality of the virus.     

Influence of the anti-T4 autoantibody cross-reacting with T3 on serum T3 level determined by RIA

We encountered a patient who showed remarkably high binding capacities of both 125I-T4 and 125I-T3, which suggests the presence of antithyroid hormone autoantibody. However, the serum level of T3 in the patient was not abnormal. Study of the specificity of anti-thyroid autoantibody revealed that the antibody present in the patient was the anti T4 antibody, which cross-reacted with T3. In addition, the binding capacity of the T4 autoantibody with T3 was inhibited by T4. Endogenous T4 is always present when T3 is determined by radioimmunoassay. Our findings indicate that the normal T3 level in the patient was because endogenous T4 inhibited the autoantibody binding with T3.     

Possible association of active gastritis, featuring accelerated cell turnover and p53 overexpression, with cancer development at anastomoses after gastrojejunostomy. Comparison with gastroduodenostomy

To cast light on tumorigenesis in the remnant stomach after distal gastrectomy for peptic ulcer or gastric cancer, 45 cases in gastroduodenostomy (Billroth I, 17 cases) and gastrojejunostomy (Billroth II, 28 cases) groups were compared for a series of parameters. Cancers in Billroth II were significantly more predominant in the anastomosis area and more frequently associated with Epstein-Barr virus infection. Active gastritis, accelerated epithelial cell turnover (as assessed by measurements of apoptosis and cell proliferation), DNA damage, and foveolar cell hyperplasia were all greater in anastomotic areas after Billroth II than in proximal areas after Billroth II or either area after Billroth I. K-ras mutations were rare, but Epstein-Barr virus infection in cancers was seen frequently in anastomosis cases. In conclusion, active gastritis, possibly induced by enterogastric reflux, is linked to tumorigenesis in anastomosis sites in Billroth II cases.     

Effect of Azelastine Hydrochloride on Macrophage Chemotaxis and Phagocytosis in Vitro

Azelastine, a newly synthesized anti-allergic agent, was tested for its effects on guinea pig macrophage chemotaxis and phagocytosis. As specific macrophage chemo-attractants, we used macrophage chemotactic factors a and c; separated and highly purified from inflamed skin sites. Macrophage chemotaxis induced by skin extract or chemotactic factors was significantly suppressed by a low concentration of the agent (1 microgram/ml); the effect was dose-dependent. The inhibition of chemotaxis was reversible, because chemotactic activity was restored when the agents was removed by washing cells before chemotactic assay. Inactivation of chemotactic factors was not detected by mixing azelastine and factors a and c. Azelastine may directly interact with macrophages to decrease their chemotactic responsiveness. beta-Glucuronidase activity in the medium and macrophages after phagocytosis of polystyrene latex particles was not affected by this agent at concentrations ranging from 1 to 10 micrograms/ml. The phagocytosis of latex particles or sheep red blood cells opsonized with IgG antibodies (EA) and anchoring of macrophages to substrate were not inhibited and azelastine did not damage the macrophages as determined by lactate dehydrogenase (LDH) release assay.     

Enhancement of drug sensitivity and a bystander effect in PC-9 cells transfected with a platelet-derived endothelial cell growth factor thymidine phosphorylase cDNA.

5''-Deoxy-5-fluorouridine (5''-DFUR) and 1-(tetrahydro-2-furyl)-5-fluorouracil (tegafur), prodrugs of 5-fluorouracil (5-FU), are anticancer agents activated by thymidine phosphorylase (dThdPase). As it is well known that the levels of dThdPase are higher in tumours than in normal tissue, it should be advantageous to use such pyrimidine antimetabolites for the selective inhibition of tumour growth. However, tumours are not necessarily sensitive to 5''-DFUR and tegafur because their levels of dThdPase vary. In this study, we examined whether transfection of tumour cells with a human platelet-derived endothelial cell growth factor (PD-ECGF) complementary DNA (cDNA) expressing dThdPase would sensitize the cells to the cytotoxic effects of pyrimidine antimetabolites in vitro. A cDNA encoding PD-ECGF was transfected into PC-9 cells (human lung adenocarcinoma). The transfected cells, PC9-DPE2, had a more than 50 times higher activity of dThdPase than the parental PC-9 cells or control PC-9 cells transfected with the pcDNA3 vector alone (PC9-D1). They were more sensitive than parental PC-9 or PC9-D1 cells not only to 5''-DFUR and tegafur but also to 5-FU. In addition, we demonstrated that PC9-DPE2 cells are able to potentiate the cytotoxic effects of 5''-DFUR towards co-cultured parental PC-9 cells. This "bystander effect'' did not require cell-cell contact. These results suggest that transfection of PD-ECGF (dThdPase) genes may be useful as a gene therapy strategy for cancer treatment.     

Effects of smoking and Japanese cedar pollinosis on lymphocyte subpopulations

Approximately 10-30% of the Japanese population suffer from Japanese cedar (Cryptomeria japonica) pollinosis in the spring. To date, the effects of this pollinosis on lymphocyte subpopulations have not been examined epidemiologically. To examine the effects of smoking and Japanese cedar pollinosis on lymphocyte subpopulations, we used flow cytometry to measure CD4+ and CD8+ T-lymphocyte subpopulations, natural-killer cell subpopulations, B(CD19+) lymphocytes, and total lymphocytes in 61 smokers and 51 nonsmokers. Some of these individuals had histories of pollinosis during November 1993-an off-season for Japanese cedar pollination. Our findings suggested that (a) CD4+ T-lymphocyte subpopulations (i.e., CD4+CD29+, CD4+CD45RA+, and CD4+ CD45RO+ cells) together with total CD4+ T, total T, and total lymphocytes, were increased by the effects of smoking; (b) CD8dim+CD11a+T, and CD8+CD11bt, and CD57+CD16+ natural killer cells, together with total CD8+CD11 a+ T and total CD8+ T lymphocytes, were increased by the effects of pollinosis on smokers, even though no lymphocyte subpopulations were increased by only the pollinosis effects; (c) CD4+CD29+T and CD8dimCD11a+ T lymphocytes were increased by the effects of smoking on pollinosis, and (d) CD4+CD29+ T and CD4+CD45RO+ T lymphocytes, CD8dim+CD11 a+ T, and CD8+CD11b+ T lymphocytes and CD57+CD16+ natural killer cells, together with total CD4+ T, total T (CD3+), total CD8+CD11a+, total CD8+ T, and total lymphocytes, were increased by the combined effects of smoking and pollinosis.     

Expandable metallic stent treatment for malignant colorectal strictures

Four patients were treated by placement of an expandable metallic stent (two Gianturco Z-stents, two Ultraflex stents) for malignant colorectal strictures. All four patients were able to defecate after stent placement. Stent migration was recognized in one patient. Two patients suffered from tenesmus after stent placement.     

Long-term survival after radical resection of advanced pancreatic cancer

A 65-yr-old man who underwent pancreaticoduodenectomy with portal vein resection for pancreatic cancer is alive 8 yr after surgery. Originally, computed tomography (CT) revealed an 8-cm tumor in the pancreatic head. The tumor had infiltrated the portal vein, but grew expansively, so there was neither biliary obstruction nor jaundice. Pancreaticoduodenectomy with resection of the portal vein was performed for pancreatic cancer. Many tumor-infiltrating lymphocytes were seen within cancer cell nests on routine histopathology. We performed immunostaining for CD8, and found that a large number of the lymphocytes were CD8⁺ T cells. The patient’s prognosis was considered poor because the tumor was large and had infiltrated the portal vein. We suspect that long-term survival may be related to the response of CD8⁺ T cells to the cancer.     

Thoracoscopic lung biopsy for diffuse infiltrative lung disease

Thoracoscopic lung biopsy is becoming the procedure of first choice for the diagnosis of many localized and diffuse lung diseases. We have performed thoracoscopic lung biopsy for 17 patients with diffuse infiltrative lung disease, in Kurume University Hospital. There were 13 females and 4 males with a mean age of 48 years (range: 19-71 years). Thoracoscopic surgical biopsy was performed in the right lung in 12 and in the left lung in 5. Adequate lung tissue from each case was obtained for pathological examination. The mean surgical biopsy time was 49 min (range: 25-72 min) and bleeding was negligible. The mean duration for chest tube drainage was 2.6 days. No postoperative complication such as prolonged air leakage occurred. A specific diagnosis from the biopsy was achieved in 13 (76.4%) of the 17 cases. In only 6 (35.2%) of the 17 cases, the pathological diagnosis was the same as that from the thoracoscopic biopsy. In these 6 cases, the same diagnosis was obtained only in those with idiopathic interstitial pneumonitis or diffuse panbronchitis. Thoracoscopic lung biopsy was safe and useful for diagnosis for diffuse infiltrative lung disease.