Thoracoscopic subtotal esophagectomy via a right thoracic cavity approach to treat an intractable fistula after 20 months from onset of an idiopathic esophageal rupture: A case report

An intractable fistula caused by idiopathic esophageal rupture is a rare but severe condition. In the present case, a 69‐year‐old man had been treated conservatively at another hospital for esophageal rupture but had developed an abscess in the left thoracic cavity due to an intractable fistula at the rupture site. He was referred to our hospital for treatment 19 months after the esophageal rupture. On admission, the intractable fistula was found to be continuous with an abscess in the left thoracic cavity. Preoperative continuous enteral nutrition was administered to improve the patient's nutritional status, and drainage was performed to reduce the size of the abscess. Then, to minimize the invasion of the intractable fistula, thoracoscopic subtotal esophagectomy was performed via a right thoracic cavity approach 20 months after the esophageal rupture. Preoperative management and thoracoscopic surgery via an opposite chest cavity approach was found to be safe and feasible for the intractable fistula caused by idiopathic esophageal rupture.     

Actin-dependent plastid movement is required for motive force generation in directional nuclear movement in plants

Nuclear movement and positioning are indispensable for most cellular functions. In plants, strong light-induced chloroplast movement to the side walls of the cell is essential for minimizing damage from strong visible light. Strong light-induced nuclear movement to the side walls also has been suggested to play an important role in minimizing damage from strong UV light. Although both movements are regulated by the same photoreceptor, phototropin, the precise cytoskeleton-based force generation mechanism for nuclear movement is unknown, in contrast to the short actin-based mechanism of chloroplast movement. Here we show that actin-dependent movement of plastids attached to the nucleus is essential for light-induced nuclear movement in the Arabidopsis leaf epidermal cell. We found that nuclei are always associated with some plastids, and that light-induced nuclear movement is correlated with the dynamics of short actin filaments associated with plastids. Indeed, nuclei without plastid attachments do not exhibit blue light-induced directional movement. Our results demonstrate that nuclei are incapable of autonomously moving in response to light, whereas attached plastids carry nuclei via the short actin filament-based movement. Thus, the close association between nuclei and plastids is essential for their cooperative movements and functions.Proper nuclear movement and positioning are essential for cellular function and organization, and defects in nuclear positioning cause impaired cellular development and diseases in animals, fungi, and plants (1, 2). Although nuclear positioning is essential primarily for determining the cell division plane, other functions of nuclear movement and positioning essential for normal development and cellular functions include directional movement and asymmetric positioning owing to internal causes or external stresses in nondividing G0 and/or G1 cells. Both actin filaments and microtubules mediate these nuclear movements in animals and fungi, and the dynamics of these cytoskeletons or motor proteins generate the motive force (1, 2). In sessile plants, chloroplasts (photosynthetic plastids) and nuclei change their intracellular positioning in response to light to adapt to fluctuating ambient light conditions, actions known as chloroplast and nuclear photorelocation movement, respectively (2, 3).Although chloroplast photorelocation movement has been studied extensively over the past 100 y (3), nuclear photorelocation movement was analyzed in detail only very recently, in the fern Adiantum capillus-veneris (4). Similar to chloroplasts, nuclei of the fern prothallus are localized to the upper periclinal walls of gametophytic cells under low light conditions (accumulation response) and on anticlinal walls under strong light (avoidance response) (4, 5). Phototropins (phot), which are blue light photoreceptors, and the related photoreceptor neochrome mediate the nuclear and chloroplast movements induced by blue and red light, respectively (6). In the flowering plant Arabidopsis thaliana, two phototropins, phot1 and phot2, mediate the chloroplast accumulation response, with phot2 involved primarily in the strong blue light-induced chloroplast avoidance response (3). In contrast, the strong blue light-induced nuclear avoidance response, which is observed in pavement and mesophyll cells (Fig. 1 and Fig. S1), is exclusively phot2-dependent (7).Open in a separate windowFig. 1.Involvement of chloroplast photorelocation movement in the nuclear avoidance response. (A) The dark position (dark) and light position (BL) of nuclei (green) in Arabidopsis pavement cells. In darkness, nuclei were located on the cell bottom (dark position). Under strong blue light, nuclei were located on the anticlinal walls (light position). (B and C) Time-course analysis of blue light-induced nuclear movement in WT (B and C, blue line), phot2-1 (B, red line), and chup1-3 (C, green line) cells. The number of nuclei in the light position was counted. Data are presented as mean ± SD. Each data point was obtained from five leaves, and 100 cells were observed in each leaf. (D) Pathways of nuclear movement during exposure to strong blue light (50 μmol m⁻² s⁻¹) for 12 h. In dark-adapted cells, the nuclei were at the cell bottom before irradiation (black spots). After 12 h of blue light irradiation, the nuclei were either attached to (red spots) or away from the side walls (red cross). (E) The highest speed of each nucleus observed during a 12-h period. The speed of each nucleus was calculated as the distance that one nucleus moved in two sequential time-lapse images. (F) Total distance traveled in 12 h. (G) The longest period that a nucleus remained on a side wall during the 12 h period. For E, F, and G, six or seven leaves (with ∼10 cells in each leaf) were observed, and the data were calculated from the paths of all of the nuclei observed. Data are presented as mean ± SD. (Scale bars: 50 μm.)Whereas the chloroplast avoidance response is an effective strong light protection response (8), the nuclear avoidance response toward the side walls of plant cells under strong light is hypothesized to be a UV protection response (2). Nuclear photorelocation movements in plants are dependent exclusively on actin filaments, similar to the situation in chloroplast photorelocation movement, where short actin filaments, termed chloroplast-actin (cp-actin) filaments, which are specifically localized around the chloroplast periphery, are involved in chloroplast attachment to the plasma membrane and chloroplast photorelocation movement by changing their distribution pattern (9, 10). However, in contrast to the intensively studied actin-based mechanism of chloroplast movement (3, 9) and cytoskeleton-based mechanism of animal nuclear movement (1), the mechanism by which the motive force for directional nuclear photorelocation movement is generated using actin filaments remains unknown.     

Effects of Steroid on Diaphragmatic Functions in Rabbits

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Myocardial perfusion and left ventricular function during exercise evaluated by 201Tl myocardial scintigraphy and 99mTc radionuclide ventriculography in patients treated with PTCA]

To evaluate the effects of percutaneous transluminal coronary angioplasty (PTCA), we investigated myocardial ischemia and left ventricular function during exercise before and after successful PTCA in 30 patients. We used extent and severity scores of 201thallium (201Tl) exercise myocardial scintigraphy to assess myocardial ischemia and determined global and regional left ventricular ejection fraction (EF and REF) of 99mTc-RBC exercise radionuclide ventriculography to assess left ventricular function. The extent and severity scores of stress images were significantly less after PTCA than before PTCA. The scores of the redistribution images were unchanged before and after PTCA. Global EF during exercise was significantly higher after PTCA than before PTCA. There was no difference in resting global EF between before and after PTCA. Myocardial ischemia induced by exercise was semi-quantitatively analyzed as transient perfusion defect with severity score. Severity score was significantly less after PTCA than before PTCA. delta EF, which was obtained by subtraction of resting global EF from exercise one, was significantly higher after PTCA than before PTCA. However, the degree of improvement in myocardial ischemia and left ventricular function varied from patient to patient. In 17 patients with one-vessel left anterior descending artery disease, delta REF, which was determined by subtracting resting regional EF from exercise one, was significantly higher in septal and apical segments after PTCA than before PTCA. Myocardial ischemia and left ventricular function under exercise were alleviated by PTCA. However, the degree of improvement varied from patient to patient and it might have been affected by various factors including coronary dissection, edema, thrombus, restenosis, spasm, side branch stenosis or occlusion, distal thrombus, and myocardial hibernation.     

Bronchial hypersensitivity to methacholine in monkeys with beta-adrenergic blockade.

In monkeys with beta-adrenergic blockade caused by administration of propranolol, we found that the conductance of the total respiratory system markedly decreased following intravenous administration of methacholine. The presence of beta-adrenergic blockade was judged from inotropic effect on the heart, levels of blood glucose and lactic acid, and the reaction of eosinophils after adrenalin injection.     

Chemotactic activity for neutrophils in allergic inflammation in rats

The number of neutrophils, eosinophils, and mononuclear cells that had migrated into pouch fluid were measured after injecting an antigen (azobenzenearsonate-conjugated acetyl bovine serum albumin) solution into air pouches made on the dorsum of immunized rats. The number of neutrophils began to increase 4 hr after the antigen challenge, reaching a maximum at 16-24 hr. Increases in the number of eosinophils and mononuclear cells were quite poor. The pouch fluid supernatant fraction was fractionated to hydrophilic and lipophilic fractions with the aid of an octadecylsilyl silica cartridge, and the chemotactic activity in each fraction was measured by the modified Boyden chamber method. The chemotactic activity in the pouch fluid supernatant fraction was the highest at 2-4 hr and decreased with time after the antigen challenge. At 16 and 24 hr, chemotactic activity was decreased to a very low level although there was a large number of neutrophils in the pouch fluid. At 4 hr, the chemotactic activity in the lipophilic fraction was significantly higher than that in the hydrophilic fraction. However, at 8 hr, the chemotactic activity in the lipophilic fraction was changed to a significantly lower level than that in the hydrophilic fraction. The chemotactic activity in the lipophilic fraction had decreased to a very low level at 8 hr. Heat treatment of the pouch fluid supernatant fraction at 92 degrees C for 5 min both at 4 and 8 hr significantly increased the chemotactic activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

A surgical case of supravalvular aortic stenosis with severe hypoplastic ascending aorta (diffuse type) in Williams-Beuren syndrome

We report a six-year-old boy who underwent ascending aortic reconstruction for supravalvular aortic stenosis of diffuse type associated with Williams-Beuren syndrome. The diagnosis was first made at the age of six months. Because of progressive left ventricular hypertrophy, cardiac catheterization was performed at the age of five years and showed left ventricular pressure of 200 mmHg, the ascending aortic pressure of 202 mmHg, the descending aortic pressure of 115 mmHg, and left ventricular end-diastolic volume of 33.5 ml (90% of normal). Whole ascending aorta except sinus Valsalva was severely hypoplastic, so called diffuse type of supravalvular aortic stenosis. The ascenidng aorta was only 6.3 mm in diameter, whereas the diameter of the aortic annulus was 20.6 mm. The ascending aortic reconstruction of Doty’s type was performed from the aortic root to the distal aortic arch with a equine pericardium reinforced by Dacron velour using selective perfusion to the right bracheocepharic artery, the left common carotid artery and the right femoral artery to avoid circulatory arrest. Postoperative course was uneventful and post operative catheterization revealed left ventricular pressure of 128 mmHg, the ascending aortic pressure of 126 mmHg and the descending aortic pressure of 90 mmHg. Mild residual pressure gradient was probably due to hypoplastic descending aorta. In conclusion, patch aortic reconstruction for ascending aorta under selective cerebral perfusion for a six-year old boy can be performed without postoperative neurological complication.