Evaluation of off-pump coronary artery bypass grafting based on systemic inflammatory response syndrome

Assessment of the less-invasiveness of off-pump coronary artery bypass grafting (OP-CAB) was made by the view point of systemic inflammatory response syndrome (SIRS). Single vessel OP-CAB with median sternotomy (MS(+)OP-CAB group, n = 13), single vessel OP-CAB without median sternotomy (MS(-)OP-CAB group, n = 9), two vessels conventional coronary artery bypass grafting (C-CAB) by normothermic extra corporeal circulation with steroid (methylprednisolone) (s(+)C-CAB group, n = 13), and two vessels C-CAB without steroid (s(-)C-CAB group, n = 13) were compared with each other. The criteria for SIRS was two or more of the following conditions: (1) temperature > 38.0 degrees C, (2) respiratory rate > 20 breaths/min, (3) heart rate > 90 beats/min, (4) white blood cells > 12,000 cells/mm3. Patients' date such as age, sex, risk factors, ejection fraction, operation time, aortic or LAD clamping time, frequency of SIRS, duration of SIRS, total application number of SIRS, mean application number of SIRS, hospitalization period, rate of renal or liver dysfunction were compared, and the following results were obtained. 1) MS(+)OP-CAB group had less-invasiveness than s(-)C-CAB group. The invasiveness of extra corporeal circulation was clear. 2) s(+)C-CAB group had equal invasiveness to MS(+)OP-CAB group. The anti-SIRS effect and organ protect effect of steroid was suggested. 3) MS(-)OP-CAB group had equal invasiveness to MS(+)OP-CAB group. The invasiveness of median full sternotomy was not so strong.     

A case of bilateral renal cell carcinoma showing a rapid course of death in a long-term hemodialysis patient due to polycystic kidney

A case of bilateral renal cell carcinoma in a 42-year-old polycystic kidney male is reported. He had been treated with hemodialysis for 22 years. An abnormal small mass was found in one of the left renal cystic lesions by screening ultrasonography and CT scan at the 19th year of the hemodialysis. Left radical nephrectomy was performed and the histological diagnosis was a renal cell carcinoma (RCC). There was no evidence of recurrence and metastasis, however, he presented with asymptomatic macrohematuria two years after the operation. CT scan demonstrated the rapidly progressing right renal tumor and multiple para-aortic lymph node swelling. Right nephrectomy and lymphadenectomy were performed and pathological examination showed the advanced RCC with multiple lymph node metastasis. Eleven months after the second operation followed by interferon therapy. he died of multiorgan metastasis of the RCC. This is the first bilateral RCC case in polycystic kidney patient treated with hemodialysis in Japan.     

The relationship between pneumatic tourniquet time and the amount of pulmonary emboli in patients undergoing knee arthroscopic surgeries

Near-fatal pulmonary embolism can occur immediately after tourniquet release after orthopedic surgeries. In this study, we determined the relationship between tourniquet time and the occurrence of pulmonary emboli in 30 patients undergoing arthroscopic knee surgeries, by using transesophageal echocardiography. The right atrium (RA) was continuously monitored by transesophageal echocardiography, and the number of emboli present was assessed with the following formula: Amount of emboli = 100 x [(total embolic area in the RA after tourniquet release) - (total area of emboli or artifact in the RA before tourniquet release)]/(RA area). The area was assessed 0-300 s after tourniquet release by using image-analysis software. The peak amount of emboli appeared approximately 50 s after tourniquet release. In addition, there was a significant correlation between amount of emboli (Ae [%]) and tourniquet time (Ttq [min]): (Ae = 0.1 x Ttq - 1.0, r = 0.795, P < 0.01). This study suggests that acute pulmonary embolism may occur within 1 min of tourniquet release and that the number of emboli is dependent on Ttq.     

Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses

BACKGROUND: In a controlled and double-blind study, the authors tested the hypothesis that preoperative insertion of intradermal needles at acupoints 2.5 cm from the spinal vertebrae (bladder meridian) provide satisfactory postoperative analgesia. METHODS: The authors enrolled patients scheduled for elective upper and lower abdominal surgery. Before anesthesia, patients undergoing each type of surgery were randomly assigned to one of two groups: acupuncture (n = 50 and n = 39 for upper and lower abdominal surgery, respectively) or control (n = 48 and n = 38 for upper and lower abdominal surgery, respectively). In the acupuncture group, intradermal needles were inserted to the left and right of bladder meridian 18-24 and 20-26 in upper and lower abdominal surgery before induction of anesthesia, respectively. Postoperative analgesia was maintained with epidural morphine and bolus doses of intravenous morphine. Consumption of intravenous morphine was recorded. Incisional pain at rest and during coughing and deep visceral pain were recorded during recovery and for 4 days thereafter on a four-point verbal rating scale. We also evaluated time-dependent changes in plasma concentrations of cortisol and catecholamines. RESULTS: Starting from the recovery room, intradermal acupuncture increased the fraction of patients with good pain relief as compared with the control (P < 0.05). Consumption of supplemental intravenous morphine was reduced 50%, and the incidence of postoperative nausea was reduced 20-30% in the acupuncture patients who had undergone either upper or lower abdominal surgery (P < 0.01). Plasma cortisol and epinephrine concentrations were reduced 30-50% in the acupuncture group during recovery and on the first postoperative day (P < 0.01). CONCLUSION: Preoperative insertion of intradermal needles reduces postoperative pain, the analgesic requirement, and opioid-related side effects after both upper and lower abdominal surgery. Acupuncture analgesia also reduces the activation of the sympathoadrenal system that normally accompanies surgery.     

Effects of Preservation of Mouse Spermatozoa in Electrolyte-Free Solution at 4°C on the Outcome of Mouse In Vitro Fertilization

Purpose: The aim was to assess the fertilizing capacity ofspermatozoa cool-preserved in electrolyte-free (EF)solution. Methods: Mouse spermatozoa were cool-preserved in EFsolution and the acrosomal status of the spermatozoa wascompared before and after preservation using chlortetracyclinestain. Mouse oocytes were inseminated by spermatozoacool-preserved in EF solution for 2, 4, or 7 days and fertilizationand blastocyst rates were evaluated. Results: Acrosomal status of spermatozoa cool-preservedin EF solution was not different from spermatozoa beforepreservation, but the capacitated and acrosome-reactedspermatozoa significantly increased after reinitiation. Cool-preservationin EF solution for up to 4 days did not affectfertilization rate. Blastocyst rate of embryos derived fromspermatozoa cool-preserved for 4 or 7 days in EF solutionwas significantly lower than that of embryos derived fromfresh spermatozoa. Conclusions: Mouse spermatozoa cool-preserved in EFsolution possesses as much fertilizing capacity as fresh spermatozoa.However, prolonged preservation affects theembryonic development.     

Technology and application of DNA array

Recently DNA macro and micro array has just begun to use for analysis of DNA expression. The array technique allows us to analyze expression pattern of several hundreds and thousands of genes simultaneously. The array method enables us to analyze gene expression levels of each gene among different samples, however it does not provide comparative analysis of the expression level of multiple genes in a single array. Because intensity of each signal on the array is normalized by the expression intensity of several standard house keeping genes, intensity of signals of each genes among different array can be compared by the number of relative intensity based on normalization. Such characteristic feature of array allows us to analyze potential function of the genes even though function of genes are not known or well characterized.     

Association of serum low-density lipoprotein metabolism with oestrogen receptor gene polymorphisms in healthy children

The aim of this study was to reveal the association of serum lipid and apolipoprotein levels with oestrogen receptor (ER) Xba I and Pvu II polymorphisms in 102 healthy Japanese school children (56M, 46F) aged 10-15 y. Each genotype of the genomic DNA extracted from peripheral leukocytes was determined using polymerase chain reaction and digestion with Xba I or Pvu II. The genotypes were coded as either X1 or X2 (Xba I) and P1 or P2 (Pvu II), when XI, P1 signified the absence of and X2, P2 the presence of restriction sites. The fasting serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride and apolipoproteins A1, B and E were measured. In the Xba I polymorphism, LDL cholesterol, apolipoprotein B levels of the XI/XI genotype were significantly higher than those of the others. The other lipid and apolipoprotein levels were not significantly different among the three genotypes. In the Pvu II polymorphism, there were no significant differences in serum lipids and lipoproteins among the three genotypes. This study reveals that Xba I polymorphisms are related to LDL metabolism. These findings support previous reports that the LDL-lowering effects of oestrogen occur through the ER (alpha) pathway. The Xba I polymorphism may be one of the genetic factors in the control of LDL metabolism.     

Acute and subacute hydrocephalus in a rat neonatal model: correlation with functional injury of neurotransmitter systems

OBJECT: The evolution and severity of hydrocephalus in animal models varies in the species and mode of induction. This makes comparisons of the physiological system under investigation difficult between models. We noted that injection of kaolin into neonatal rats results in a dichotomous outcome into either an acute or subacute form. We investigated the clinical and functional transmitter system changes to compare these two types of hydrocephalus evolution. METHODS: Hydrocephalus was induced in Wistar neonatal rats (within a week after their birth) by intracisternal injection of 0.02 ml volume of 25% kaolin solution under microscopic guidance. The same volume of sterile saline was injected into 12 neonatal rats as control group. The animals were assigned to either the acute or subacute group according to their head size, and sacrificed at 2, 4 and 8 weeks after injection. Biparietal diameter, ventricular size, cholinergic interneurons in the neostriatum and dopaminergic projection neurons in the substantia nigra were analyzed at each stage. RESULTS: Animals affected with the acute type of hydrocephalus had obvious head enlargement, rapid ventricular enlargement, and all died at about 4 weeks. Animals with subacute type had slowly progressive ventricular enlargement, and all survived until 8 weeks. There appeared to be more kaolin ventral to the brainstem in the acute type. The number of cholinergic neostriatal neurons was significantly reduced at 2 and 4 weeks in the acute type, but only at 8 weeks in the subacute type. The number of dopaminergic nigral neurons was decreased at 4 weeks in the acute type, but unaffected in the subacute type. CONCLUSIONS: The severity of onset of hydrocephalus in this animal model also correlates with the clinical outcome and changes in functional transmitter systems.     

Temporal and geographical variation in epidemics determined from the results of an infectious disease surveillance system in Japan description of epidemic patterns by data-based criteria for epidemic periods

OBJECTIVE: After developing criteria for epidemic periods for 16 infectious diseases, we investigated temporal (annual and monthly) and geographical (regional) variation in epidemics. METHODS: Data from an infectious disease surveillance system for the years 1993 to 1997 were used for the analysis. The weekly number of patients per monitoring station was calculated from the data and used in developing criteria for an epidemic period. Based on these latter, we calculated the average number of epidemics occurring at each public health center in a year, an average length of the epidemic period, and the average number of patients per monitoring station reported during an epidemic period. These figures were used to explore temporal (annual, monthly) and geographical (regional) variation. RESULTS: With most diseases, the average number of epidemics occurring at a public health center was 0.3-0.5 per year and the average length of an epidemic period was 6-12 weeks. The average number of patients per monitoring station reported during an epidemic period differed according to the diseases. These indices showed that there were few annual differences, but great monthly differences, in most diseases. The average number of epidemics occurring in a public health center showed regional differences with some diseases. CONCLUSION: Temporal and geographical variation in epidemics for 16 infectious diseases was established by developing criteria for an epidemic period.