A patient with severe ventricular tachycardia who was saved by prolonged extracorporeal lung and heart assist]

A 47-y-o man had been suffering from cardiac failure due to refractory ventricular tachycardia (VT) after myocardial infarction. He underwent resection of the left ventricular aneurysm and cryocoagulation of the arrhythmogenic foci. On the 2nd post-operative day, VT often recurred in spite of repeated cardioversion and drug therapy, and threatened his life, even under IABP. Therefore, a veno-arterial bypass route was made and extracorporeal lung and heart assist, ECLHA, was started with a heparin bonded Maxima lung on the following day. Even under ECLHA, VT continued to recur. Cryocoagulation of the VT foci was tried again, without immediate success. A record high dose of beta-blockers, given under the circulatory support by ECLHA, stopped VT on the following day. The patient was weaned from the ECLHA circuit 12 days after the first operation, then from IABP on the 14th day. During the 10 day course of surgeries and ECLHA, the patient had almost 100 defibrillations. But for ECLHA, we may say that the patient couldn't have survived two open heart surgeries, administration of a great amount of beta-blockers, and repeated cardiac arrest without neurological sequelae.     

Different origin of leiomyoblastoma by immunohistochemical study.

Leiomyoblastoma has been regarded as a neoplasm of smooth muscle origin. With recent progress in immunohistostaining techniques, many clinicopathological discrepancies have been pointed out about the origin of leiomyoblastoma. It has been claimed that gastrointestinal non-epithelial tumors should be regarded as stromal tumors in order to study their origin. In the present study, we performed various forms of immunohistostaining in seven cases of leiomyoblastoma to determine their origin. One case expressed desmine and muscle specific actin and was considered to be derived from smooth muscle. Four neoplasms expressed X-100 protein (two cases were also NSE positive) and were thought to be derived from the nerve. Two cases were of unknown derivation. These results suggest that the cells of leiomyoblastoma may arise from a primitive to totipotential cell of neural lineages that may anomalously express smooth muscle filaments.     

Deep vein thrombosis in the psychiatric patients under physical restraint]

Pulmonary thromboembolism induced by deep vein thrombosis (DVT), which is known as economy-class syndrome, is one of sudden death in psychiatric patients under physical restraint. (1) A decrease in venous blood flow, (2) damage to vessel walls, and (3) the enhancement of blood clotting are the major risk factors for DVT (Virchow triad). It has been speculated that physical restraint inhibits venous blood flow, and that antipsychotic drugs facilitate blood clotting. In order to prevent sudden death due to DVT, prophylactic measures and early diagnosis are crucial. Whereas Doppler ultrasonography and contrast venography are the gold standards for the diagnosis of DVT, more simplified methods are now under development. Of those, D-dimer measurement, which can be conducted with a small blood sample, is the most potent candidate for the biochemical diagnosis of DVT. Although there are many prophylactic measures, including anticoagulant medications and physical therapies, it is not clear which is the most effective and suitable in psychiatric practice. Psychiatric professionals should pay closer attention to DVT in psychiatric patients under physical restraint.     

Investigation of where schizophrenic patients receive treatment

Schizophrenic patients receiving treatment in Kagawa Prefecture were studied as to where treatment was obtained. Analysis showed that there was a tendency by schizophrenic patients to seek treatment in institutions distant from their place of residence. The direction in which a patient proceeded to seek treatment varied and showed no pattern. Analysis by age groups showed that patients in the 15 to 39 years age group were most likely to seek treatment in locations other than where they lived and traveled the longest distance. The tendency to seek treatment away from their place of residence decreased with increasing age. However even among the elderly there were patients who traveled long distances for treatment. Factors associated with geographical or social relationships between the cities/towns could not explain the tendency observed. Neither was there a relationship to specialized medical care. Factors such as the related to the mental health care system, including prejudice and lack of societal understanding were inferred to be associated to this problem. Results of this study indicate a need to organize the community mental health system to serve districts with wider areas than that established for other diseases. However in the future there should be a gradual narrowing of the district area, a broadening of services offered, and a removal of societal prejudice against psychiatric patients.     

The effects of anesthesia on otoacoustic emissions

We have measured transient-evoked and distortion-product otoacoustic emissions (OAEs) in the chinchilla and compared them in the awake and anesthetized animal (using either ketamine or barbiturate agents). We report a significant increase in OAE amplitudes during anesthesia, particularly using ketamine. These effects are most evident for transient-evoked otoacoustic emissions (TEOAEs) as measured in the non-linear mode. Our data support the hypothesis that tonic activity levels in cochlear efferents may be reduced by anesthetic effects, either directly or indirectly (e.g., by general reductions in descending pathway activity), and that reduced cochlear efferent activity will result in the observed increase of OAE amplitudes.     

Effects of suramin on metastatic ability,proliferation, and production of urokinase-type plasminogen activator and plasminogen activator inhibitor type 2 in human renal cell carcinoma cell line SN12C-PM6

Effects of suramin, a polysulfonated naphthylurea compound, on metastatic ability, proliferation, and production of plasminogen activators and plasminogen activator inhibitors were studied using the highly metastatic human renal cell carcinoma cell line, SN12C-PM6. After renal subscapular implantation of tumor cells in nude mice, suramin significantly inhibited metastasis of tumor cells to the lungs and liver. In vitro growth of tumour cells was inhibited by suramin in a dose-dependent manner, at relatively low doses (ID₅₀ = 105 µg/ml). Plasminogen activator inhibitor type 2 (PAI-2) production by tumor cells was enhanced by suramin (100 µg/ml), whereas urokinase-type plasminogen activator (uPA) production was suppressed. Thus, the increase in PAI-2 and the decrease in uPA production correlated with the inhibitory effects on tumour growth and metastasis by suramin. Therefore suramin may be beneficial for the treatment of patients with an early stage of renal cancer with potential risk of metastasis.     

C and V proteins of Sendai virus target signaling pathways leading to IRF-3 activation for the negative regulation of interferon-beta production

We here report a molecular basis for downregulation of interferon (IFN)-beta production by V and C proteins of Sendai virus (SeV). The infection of HeLa cells with SeV poorly induced IFN-beta even if the expression of C/C' was disrupted. In contrast, when the expression of C/C'/Y1/Y2 or V/W was disrupted, SeV infection strongly induced IFN-beta production and significantly activated the interferon regulatory factor (IRF)-3 pathway. The independent expression of C or V inhibited the double-stranded (ds) RNA- or Newcastle disease virus (NDV)-induced activation of IRF-3 and NF-kappa B, as well as the IFN-beta promoter. This inhibitory effect was also observed when Y1, Y2, or a C-terminal half fragment (aa 85-204) of C was independently expressed. Phosphorylation and homodimer formation of IRF-3 were suppressed not only in cells infected with SeV capable of expressing both C/C'/Y1/Y2 (or Y1/Y2) and V/W, but also in HeLa cells constitutively expressing Y1. These results suggest that C, Y1, Y2, and V block signaling pathways leading to IRF-3 activation to downregulate IFN-beta production.     

Probable implication of mutations of the X open reading frame in the onset of fulminant hepatitis B

A pathogenic role of precore-defective mutation in the onset of fulminant hepatitis B has been suggested. However, precore-defective mutants do not always cause fulminant hepatitis B and are not always isolated from affected patients. These findings strongly suggest the presence of some additional important mutations outside the precore region in fulminant hepatitis. In the present investigation an attempt was made to sequence the X open reading frame of hepatitis B virus DNA isolated from seven patients with fulminant hepatitis B and five patients with acute hepatitis B. The latter were used as controls. Since the X open reading frame encodes the X protein and contains the core promoter/enhancer II complex, some critical mutations may enhance or disrupt the replication and expression of hepatitis B virus DNA leading to fulminant hepatitis. A C-to-T substitution was found at nucleotide (nt) 1655, an A-to-T substitution at nt 1764 and a G-to-A substitution at nt 1766 in 4, 5 and 5 patients, respectively, out of the seven with fulminant hepatitis. These substitutions were not recognized in the patients with acute hepatitis. These mutations might change the function of the X protein and core promoter/enhancer II complex. It is suggested, therefore, that these mutations, as well as the precore-defective mutation, may play an important role in the pathogenesis of fulminant hepatitis. © Wiley-Liss, Inc.