Natural Killer Activity of Pediatric Patients with Acute Lymphoblastic Leukemia in Remission

We examined the natural killer (NK) activity of pediatric patientswith acute lymphoblastic leukemia (ALL) in remission by usingseveral methods, including a newly established single cell assay.HNK-1 antigen-positive cells, which are now considered to assumeNK activity, were not decreased in the patients, although theNK activity of the patients was found to be depressed. Neithermonocyte depletion nor the addition of interferon- improvedthe decreased NK activity of the patients. According to the results of the single cell assay, conjugate-formingcells (effector cells that form conjugates with target cells),lytic conjugate-forming cells (fractions of conjugate-formingcells that actually go on to kill target cells) and the recyclingactivity of NK cells were all decreased in the patients. Thus,it is apparent that there were defects in several steps of NKactivity in the patients. The NK activity of 19 patients wasfurther studied successively to investigate the correlationbetween NK activity and clinical course. The longest observationperiod was 38 months. Six bone marrow relapses of leukemia occurred,but the NK activity of these patients at the time of relapseor at the previous test was not necessarily depressed as comparedto that of the other patients.     

Clinical Effect of Cisplatin (NK-801) on Head and Neck Cancer

Twenty-one patients with head and neck cancer were treated withcis-diamminedichloroplatinum (cisplatin). Two kinds of regimenwere used in this study: a low-dose regimen (7 mg/m² 3-hr intravenous(i.v.) infusion or an intraarterial (i.a.) push injection, days1–5, q 3 wk) and a high-dose regimen (50 mg/m² 24-hr i.v.infusion or a 2-hr i.a. infusion, q 3 wk). Nine patients weretreated before radiotherapy or surgery for stage III or IV diseaseand the remaining 12 were treated for recurrent or metastaticdisease. The tumors were 18 squamous cell carcinomas, 2 adenocarcinomasand one adenoid cystic carcinoma. The overall response rate was 35% with two complete responsesand five partial responses ( 50% regression). With the high-doseregimen there were two complete responders and four partialresponders, while in the low-dose regimen only one partial responsewas observed. There was no difference in therapeutic effectdue to the route of administration. Toxicity was minimal: no patients had creatinine levels of >2mg/dl; there were leucopenia (<3,000/mm³) in one patient,nausea and vomiting in 62%, and minimal hearing impairment intwo patients. The most impressive point regarding this agent is that responsesare complete in some patients with long periods of remission. We conclude that cisplatin is an effective new agent for squamouscell carcinoma of the head and neck. Further studies shouldbe performed for the purpose of developing new combinationsof chemotherapeutic agents that include this one.     

Hydronephrosis in the early stage of pregnancy after renal transplantation

A 28-year-old woman with end-stage renal disease due to congenital hypoplasia and vesicoureteric reflux in the bilateral kidneys received a renal transplant from her 52-year-old mother. She became pregnant 3 years later. The serum creatinine level was 1.6 mg/dL with a creatinine clearance of 27.3 mL/min/1.48 m(2) just prior to pregnancy. Her graft showed hydronephrosis at 12 weeks of pregnancy. At 25 weeks a double J-type stent catheter was placed, without exposure to radiation, because of progressive deterioration of the graft hydronephrosis. Hydronephrosis partially improved, but her serum creatinine level further increased to 2.3 mg/dL. She delivered a healthy boy by routine caesarean section at 34 weeks of pregnancy. Computed tomography demonstrated the ureter wedged between the gravid uterus and the graft. The catheter was removed 10 days postpartum. Six months later, ultrasonographic study did not show hydronephrosis and the serum creatinine level was 2.0 mg/dL.     

Ability of Activation Recovery Intervals to Assess Action Potential Duration During Acute No-Flow Ischemia in the In Situ Porcine Heart

Activation Recovery Intervals During No-Flow Ischemia . Introduction : The ability to assess transmural changes in action potential duration during acute no-flow ischemia is essential to an understanding of the tachyarrhythmias that occur in this setting. The purpose of this study was to determine if activation recovery intervals determined from unipolar electrograms would provide this information.
Methods and Results : We recorded simultaneously transmembrane action potentials and unipolar electrograms from sites located as closely together as possible in the center and at the lateral margin of the ischemic zone during acute no-flow ischemia and correlated the changes in activation recovery intervals obtained from the unipolar electrograms to the changes in action potential duration. We found that the activation recovery intervals provided an accurate measure of the changes in action potential duration during acute no-flow ischemia provided the electrograms had a well-defined, single negative component to the QRS complex with a maximum negative dV/dt > 10 V/sec and a single positive component to the T wave having a maximum positive dV/dt > 1.6 V/sec. Electrograms meeting these criteria comprised 90% of the electrograms recorded at the margin of the ischemic zone throughout 60 minutes of no-flow ischemia. In the center of the ischemic zone, 75% of the recorded electrograms met these criteria for the first 20 minutes of no-flow ischemia. Thereafter, the percentage declined and after 40 minutes of no-flow ischemia, none of the electrograms recorded in the center of the ischemic zone met these criteria.
Conclusion : Activation recovery intervals obtained from unipolar electrograms provide an accurate assessment of changes in action potential duration throughout the ischemic zone during acute no-flow ischemia, provided the characteristics of the electrograms meet specific predetermined criteria.     

Comparative Efficacy of Subcutaneous Mesh and Plate Electrodes for Nonthoracotomy Canine Defibrillation

To determine the optimal configuration for the subcutaneous placement of electrodes for the performance of ventricular defibrillation without thoracotomy, internal defibrillation using four different subcutaneous electrodes was performed in 13 anesthetized dogs (7-12 Kg, mean +/- SD: 9.2 +/- 1.5 Kg). An electrode (7 cm2) was positioned transvenously in the superior vena cava with the following electrodes randomly implanted subcutaneously on the left chest: small mesh electrode (14 cm2), large mesh electrode (28 cm2), small titanium plate electrode (14 cm2), and large plate electrode (28 cm2). Ventricular fibrillation was induced by applying alternating current; a monophasic defibrillation wave was administered between the superior vena cava and the subcutaneous electrodes 10 seconds later. The energy level associated with a 50% successful defibrillation, as predicted by logistic regression analysis, was defined as the ED50. After the completion of the defibrillation protocol using the four subcutaneous electrodes, the small mesh electrode was sutured to the epicardium and the ED50 measurements were repeated. Energy ED50s were lower when the superior vena cava electrode was used as the cathode rather than as the anode. Of the subcutaneous electrodes, the large plate electrode showed the lowest energy ED50 (3.3 +/- 0.9 joules). The plate electrodes had lower energy ED50s than the mesh electrodes, and the large electrode had a lower energy ED50 than the small electrodes. Using the epicardium electrode, transient arrhythmias and ST elevation were observed following successful defibrillation; however, no arrhythmias or ST-T changes were observed following defibrillation using the subcutaneous electrodes.(ABSTRACT TRUNCATED AT 250 WORDS)     

High Energy Radiofrequency Catheter Ablation for Common Atrial Flutter Targeting the Isthmus between the Inferior Vena Cava and Tricuspid Valve Annulus Using a Super Long Tip Electrode

There have been controversies concerning the optimal target sites and approaches in radiofre-quency catheter ablation of common atrial flutter. We attempted high energy radiofrequencv catheter ab-lation targeting the isthmus between the inferior vena cava and tricuspid valve annulus (IVC-TV isthmus) with a super long (8 mm) tip electrode, and compared the efficacy of this anatomical approach with the electrophysiological approach targeting the posteroseptal right atrium posterior to the coronary sinus us-ing a standard 4-mm tip electrode. Atrial flutter was successfully ablated in 12 of 12 patients (100%) with-out recurrence with the anatomical approach, while, in 7 of 9 patients (64%) with 2 recurrences with the electrophysiological approach. In comparison of ablation data between the anatomical and electrophysi-ological approaches, there were significant differences in the mean number of application pulses (anatomical vs electrophysiological: 2.3 ± 0.8 vs 9.9 ± 6.4, P < 0.01), applied wattage (39 ± 12Wvs24 ± 6W.P < 0.01), applied energy per application (1.986 ± 426 / vs 659 ± 323 J. P < O.O1), fluoroscopic time (26 ± 11 min vs 74 ± 30 minutes, P < 0.01), and procedure time (59 ± 8 min vs 181 ± 53 min. P < 0.01). In conclusion, the anatomical approach is superior to the electrophysiological one with respect to proce-dure and radiation time, and linear ablation at the IVC-TV isthmus with an 8-wm tip electrode and high energy application is highly effective and safe.     

Differences of LAK-activity and IL-2 responsiveness between α/β and γ/δ T cells which developed after thymus transplantation

A patient with severe combined immunodeficiency was transplanted with T cell depleted haploidentical bone marrow from his father and was later given a thymic graft from an unrelated donor, α/β and γ/δ T cells of bone marrow donor origin appeared only after the thymus transplantation procedure. Among the peripheral blood lymphocytes (PBL), γ/δ T cells comprised 10–20% and most of them were δTCS1⁺. The α/β T cells were single positive cells, either CD4⁺ or CD8⁺. Expression of CD5, CD7 and CD8α,β molecules on α/β T cells was reduced. Functional studies showed that γ/δ T cells proliferated slightly in response to anti-CD3 stimulation, and proliferated well with exogenous IL-2 stimulation, while α/β T cells did not proliferate following mitogenic stimulation even in the presence of IL-2. γ/δ T cells but not α/β T cells exhibited some LAK activity after culturing with IL-2. Since α/β T cells expressed IL-2R α and β chains after mitogenic stimulation and bound IL-2, the deficit(s) in these cells was considered to occur after IL-2 binding to the IL-2R. These results indicate thymic dependency of both types of T cells and that two types of T cells differed in the acquisition of IL-2 responsiveness during development.     

Whole body oxygen consumption during extracorporeal hepatic resection: Usefulness of continuous monitoring of mixed venous oxygen saturation

Whole body oxygen consumption was measured using a thermodilution fibreoptic catheter in two patients undergoing extracorporeal hepatic resection. Each patient had virtually normal liver function before the operation. Anaesthesia was induced and maintained in a standard fashion and a venovenous bypass instituted. The anhepatic periods were 302 and 157 min. Upon removal of the liver, the oxygen consumption decreased by about 40% (50 mL/min), while the mixed venous oxygen saturation increased by about 15%. Following re-implantation, the oxygen consumption recovered and increased transiently above control values, while the mixed venous oxygen saturation changed in a reciprocal way. Monitoring whole body oxygen consumption instead of hepatic oxygen consumption seemed helpful in estimating restoration of blood flow and functions in the liver after reperfusion. It was also suggested that changes in oxygen consumption as well as those in cardiac output and haemoglobin concentration could be predicted easily by continuous monitoring of mixed venous oxygen saturation during the peri-anhepatic period.     

Linear Childhood Discoid Lupus Erythematosus Following the Lines of Blaschko: Successfully Treated with Topical Tacrolimus

Abstract: The linear arrangement of discoid lupus erythematosus is uncommon. Here, we report a 6‐year‐old Japanese girl with linear discoid lupus erythematosus following the lines of Blaschko on her face and neck. Topical tacrolimus treatment improved the eruptions. The present case also indicated the important role of epidermal and dermal cells as well as immune cells in the pathogenesis of cutaneous lupus erythematodes.