Combined therapy with prostaglandin E1 ointment and lumbar sympathetic ganglion block on intractable skin ulcers accompanied by Bürger's disease]

For the 2 patients with intractable skin ulcers and pain accompanied by thromboangiitis obliterans (Bürger's disease), we applied combined therapy with lumbar sympathetic block, continuous epidural block and prostaglandin E1 ointment. Prostaglandin E1 (PGE1) was prepared as a topical ointment by mixing with Plastibase (polyethylene resin, 5%, liquid paraffin, 95%) at a concentration of 10 micrograms.g-1. The ointment was kept in a refrigerator until use. Following debridement and washing of the surface of ulcers as required, the ointment was applied evenly onto the surrounding and over the surface of each ulcer 2 times daily after sterilization. With this therapy the ulcers were cured completely in 10 days after the start of treatment. No side effect was observed both locally and systemically. Although the combined therapy we used with prostaglandin E1 ointment was a noninvasive method, a remarkable shortening of the period of treatment was achieved.     

Functional role of cation-independent mannose 6-phosphate/insulin-like growth factor II receptor in cell adhesion and proliferation of a human myeloma cell line OPM-2

The molecular mechanism underlying the interaction between myeloma cells and stromal cells was investigated by using a human myeloma cell line (OPM-2) and human umbilical vein endothelial cells (HUVECs). Adhesion of OPM-2 cells to HUVECs was found to be significantly augmented with treatment of OPM-2 cells with an alpha-glycosidase inhibitor, castanospermine (CSP). The treatment of OPM-2 cells with CSP resulted in alteration of oligosaccharide structures of cell surface glycoproteins particularly at molecular weight of 220 kD (GP220). To determine if GP220 was involved in the adhesion of OPM-2 cells to HUVECs, cell surface glycoproteins of HUVECs were labeled by biotin and were incubated with the PVDF membrane to which cell surface glycoproteins of OPM-2 cells were blotted. The biotinylated glycoproteins at the plasma membrane of HUVECs specifically bound to GP220 of OPM-2 cells. Purification and partial amino acid sequencing of GP220 revealed that GP220 had a structure homologous to cation- independent mannose 6-phosphate/insulin-like growth factor-II (CIM6P/IGF-II) receptor. Furthermore, an antibody against CIM6P/IGF-II receptor was reactive with GP220, indicating that GP220 was a CIM6P/IGF- II receptor. The adhesion of OPM-2 cells to HUVECs was inhibited by mannose 6-phosphate. Moreover, M6P was found to suppress the adhesion of human myeloma cell lines, OPM-2 and RPMI 8226, to bone marrow stromal cells that was established from the patients with multiple myeloma. In addition, proliferation of OPM-2 was stimulated in response to IGF-II. These results suggest that CIM6P/IGF-II receptor may be functional in terms of supporting cell adhesion and proliferation of myeloma cells.     

A clinical study of postoperative infections following open-heart surgery: Occurrence and microbiological findings in 782 cases

A total 782 consecutive patients underwent open-heart surgery with CPB between January, 1979 and December, 1988, at the Yamagata University Hospital. We assessed the incidence of postoperative infections in relation to age, the duration of surgery and antibiotic prophylaxis, and examined the causative organisms, after which the types of infecting flora were compared between the 1st period, from 1979 to 1983 and the 2nd period, from 1984 to 1988.Postoperative infection occurred in 104 of the 782 patients (13.3 per cent); in the form of a wound infection in 41 (5.2 per cent), pneumonia in 33 (4.2 per cent), urinary tract infection in 9 (1.2 per cent), prosthetic valve endocarditis in 6 (0.8 per cent), and other infections in 15 (1.9 per cent). Patients aged under 12 months or over 60 years showed a higher incidence of infection, being 17.4 per cent and 19.2 per cent, respectively. Patients who underwent an operation of over 8 hours duration also had a significantly higher incidence compared to those whose operation time was less than 4 hours, being 32.9 per cent and 6.3 per cent, respectively (p<0.0001). There was no significant difference in the incidence of postoperative infection between patients given or not given preoperative prophylaxis. A total 123 species of organisms were isolated from the 104 patients, 52.8 per cent being gram-negative bacteria (GNB), and 43.9 per cent grampositive bacteria (GPB), and a remarkable increase in the incidence of GPB was seen in the 2nd period compared to the 1st period from 31.7 per cent to 50.0 per cent.There has been a recent increase in the number of high risk patients compromised by the severity of an underlying disease. Thus, to control infection, the surgical environment and aseptic technique seem more important than antibiotic prophylaxis.     

Variation in the calpain-10 gene affects blood glucose levels in the British population.

Variation in the calpain-10 gene (CAPN10) has been shown to be associated with type 2 diabetes in Mexican-Americans and in at least three Northern European populations. Studies in nondiabetic Pima Indians showed that one of the at-risk DNA polymorphisms, single-nucleotide polymorphism (SNP)-43, in CAPN10 was associated with insulin resistance, and individuals with the G/G-genotype had significantly higher fasting plasma glucose and 2-h insulin concentrations after a 75-g oral glucose tolerance test (OGTT). We have examined the effect of variation in CAPN10 on plasma glucose and insulin levels in a group of 285 nondiabetic British subjects after a 75-g OGTT. The results showed that subjects with G/G genotype at SNP-43 had higher 2-h plasma glucose levels than the combined G/A + A/A group (P = 0.05). We also examined the SNP-43, -19, and -63 haplotype combination 112/121, which is associated with an approximately threefold increased risk of diabetes. Subjects with the 112/121 haplotype combination (n = 29) had increased fasting (P = 0.004) and 2-h plasma glucose levels (P = 0.003) compared with the rest of the study population after correction for age, sex, and BMI. The 112/121 haplotype combination was also associated with a marked decrease in the insulin secretory response, adjusted for the level of insulin resistance (P = 0.002). We conclude that genetic variation in the CAPN10 gene influences blood glucose levels in nondiabetic British subjects and that this is due, at least in part, to the effects of calpain-10 on the early insulin secretory response.     

Humidification during low-flow anesthesia in children

Purpose The aim of this study was to compare the effect of low-flow anesthesia with or without a heat and moisture exchanger with high-flow anesthesia on airway gas humidification in children. Methods One hundred twenty children were randomly assigned to one of three groups: low-flow anesthesia with 0.5l·min⁻¹ of total gas flow (LFA,n=40), low-flow anesthesia with 0.5l·min⁻¹ using a heat and moisture exchanger (HME,n=40), and high-flow anesthesia with 6l·min⁻¹ (HFA,n=40). The temperature and relative humidity of the inspired gas were measured throughout anesthesia. Results The relative humidity of the inspired gas in the HME group was increased compared with that of the LFA and HFA groups 20 min after induction (p<0.05). The airway humidification in the LFA group was higher than that in the HFA group 10 min after induction (p<0.05). The temperature of the inspired gas in the HME group was increased compared with that in the LFA and HFA groups after 70 min (P<0.05). Conclusion Low-flow anesthesia is less effective in providing adequate humidification of inspired gas than low-flow anesthesia with a heat and moisture exchanger, but significantly better than high-flow anesthesia in children.     

Intraoperative radiotherapy for gliomas

Summary Intraoperative radiotherapy (IORT) was performed in 20 of 36 patients with glioma; 11 glioblastomas, 7 malignant astrocytomas, 2 benign astrocytomas. Twenty or 25 Gy of irradiation was delivered in a single fraction intraoperatively, followed by external beam irradiation. The electron beam energy was selected so that the 80% isodose line fell at 2 or 3 cm below the residual tumor surface. Median survival time of IORT group was 14 months and that of the control group was 10 months. Difference of survival curve was significant. There were 6 incidences of complication caused by IORT; 1 radionecrosis, 1 convulsion, 1 abscess, and 3 severe brain edemas. IORT is suited for the treatment of malignant gliomas.     

Theophylline protects against glycerol-induced acute renal failure: Regulation of heme oxygenase-1 and glutathione in rat kidney

Background To investigate the mechanism of glycerol-induced renal injury, we examined kidney levels of the cellular antioxidant glutathione and heme oxygenase-1 (HO-1), the rate-limiting enzyme in heme degradation, after glycerol injection. Methods Male Wistar rats were injected with glycerol to induce acute renal failure. Serum creatinine levels were used as a marker of renal function at 24 hours after glycerol injection. Theophylline and buthionine sulfoximine or vehicle were administered to the rats after glycerol injection, and we determined renal glutathione levels (by biochemical assay) and the levels of HO-1 protein and messenger ribonucleic acid (mRNA; using immunoblot analysis [kidney only]) in various rat organs at 24 hours after glycerol injection. Results Glutathione levels abruptly declined after glycerol injection, reached a minimum at 4 hours, then returned to about two thirds of control levels at 24 hours. HO-1 protein was detected at 4 hours and reached a maximum at 24 hours. The induction of HO-1 protein was observed only in the kidney. HO-1 mRNA was faintly expressed at 2 hours, increased until at least 8 hours, and was not detected 24 hours after the treatment. When theophylline was administered to glycerol-injected rats, renal function improved and glutathione levels increased. In addition, the levels of HO-1 protein decreased, compared with those of glycerol-treated rats not given theophylline. Conclusions These results suggest that theophylline may act by modulating the HO-1 directly or indirectly.     

Laparoscopic resection for nonfunctioning small glucagon-producing tumor: report of a case and review of the literature

Glucagonoma is a relatively rare type of pancreatic endocrine tumor, and is often well-developed and malignant at detection. We report a case of nonfunctioning small glucagon-producing tumor that was successfully resected by laparoscopic surgery. A 63-year-old woman was admitted to our hospital for further examination of a pancreatic tumor that had been detected incidentally. Hematological data and hormone concentrations were within normal ranges. Abdominal ultrasonography and computed tomography showed a small mass in the body of the pancreas. Laparoscopic distal pancreatectomy was done. Macroscopically, the resected tumor was a yellowish-white, solid mass measuring 8 × 8 × 7?mm. The tumor cells showed positive immunohistochemical staining for chromogranin A and glucagon. The postoperative course was uneventful. To the best of our knowledge, this is the first report of laparoscopic surgery for a nonfunctioning small glucagon-producung tumor. Because of recent improvements in laparoscopic surgery technique, use of this approach for resection of pancreatic benign small endocrine tumors will likely increase in the future.