Plasma Factor Triggering Alternative Complement Pathway Activation by Liposomes

Several plasma components, such as complement (C) components, play a role in the clearance of liposomes from the circulation. The interactions between liposomes and the C system were investigated in this study. Multilamellar vesicle (MLV) liposomes, which were damaged by activation of the complement, became susceptible depending on the density of cetylmannoside (Man) on the liposome membrane, and activation proceeded through the alternative C pathway as observed for liposomes without Man (PC-MLV) (K. Funato et al, Biochim. Biophys. Acta 1103:198–204, 1992). In addition, the capacity of Man-modified liposomes (Man-MLV) to activate the alternative C pathway was abolished by preadsorption of plasma with Man-MLV but not with PC-MLV. The results suggest that a specific plasma factor adsorbed with Man-MLV was responsible for the augmentation of the C activation and, further, that the rapid clearance of Man-MLV from the circulation is caused by both enhanced C-mediated liposome permeability and enhanced C-mediated phagocytosis of liposomes.     

Increase in choroidal blood flow in rabbits with endothelin-1 induced transient complete obstruction of retinal vessels

Background: In a previous paper, we reported that retinal blood flow (RBF) ceased immediately after injection of 1 nmol endothelin-1 (ET-1) and no recovery of RBF was detected for at least 50 min. In this study, we confirmed the same duration of RBF cessation and measured choroidal blood flow (CBF) for 180 min. Methods: We measured CBF in a rabbit model of transient complete obstruction of retinal vessels induced by intravitreal injection of a high dose of ET-1, using the hydrogen clearance method. We also investigated the effects of intravitreal injection of ET-1 on intraocular pressure (IOP), blood pressure, pulse rate and blood gases. Results: CBF was significantly greater in the ET-1-injected eyes than in the control eyes 40–130 min after injection of ET-1 (P < 0.05). The maximal CBF ratio in the ET-1-injected eyes was 128 ± 7.4% at 40 min. CBF decreased to the pre-injection level at 140 min after the injection of ET-1. There was no significant change in blood pressure, pulse rate and blood gases throughout this experiment, and there was no significant difference in IOP between ET-1-injected eyes and control eyes. Conclusion: It seems likely that the increase in CBF resulted from some local mechanisms of control that compensated for the decrease in RBF induced by intravitreal injection of ET-1. This model may be useful for investigation of the regulatory system of intraocular circulation, including endothelin receptors.     

Imaging features of pancreatoblastoma: a case report

We present a patient with pancreatoblastoma along with a discussion of various cross-sectional imaging features. The tumor was a large multilocular cystic mass with solid components in the left retroperitoneal space. There were fine internal echoes on ultrasonography, and the signal intensity was high on both T1- and T2-weighted MR images in most of the locules, suggesting the presence of hemorrhagic debris. Among the various retroperitoneal organs displaced by the tumor, only the pancreatic tail was inseparable from the mass, suggesting that the pancreatic tail was the origin of the tumor. Pancreatoblastoma should be included in the differential diagnosis when a large left upper quadrant mass with these imaging features is seen in infants and young children.     

Postoperative mediastinitis after the coronary artery bypass grafting using internal thoracic artery graft

It has been pointed out in general that the resistance against infection is decreased in the diabetic patients. This problem is very important in patients undergoing major surgery. In cardiovascular surgery, the median wound infection may result in life threatening sequelae. We have used the internal thoracic artery as the appropriate graft for its excellent long-term patency. In this series of the diabetic patients who underwent coronary artery bypass grafting with bilateral internal thoracic artery grafts, the incidence of postoperative mediastinitis was significantly higher than other cases. Therefore the use of bilateral internal thoracic artery grafts should be avoided, if possible in the diabetic patients.     

Laparoscopic partial adrenalectomy

Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described. Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors were evaluated by preoperative thin-slice computed tomography (CT) scan. (c) Solitary lesions were reconfirmed with intraoperative ultrasonography. (d) Partial adrenalectomy was performed with at least a 5-mm margin using a vascular stapler. Results: Laparoscopic partial adrenalectomy was performed in five patients using the vascular stapler. Hemostasis was perfect in all five patients. The tumor was located in the inferior part of the right adrenal gland in three cases and in the upper pole of the left adrenal gland in two cases. The postoperation pathologic diagnosis was adrenocortical adenoma in all five patients, and excessive hormonal levels or symptoms all disappeared. Conclusions: Laparoscopic partial adrenalectomy can be performed safely using a vascular stapler. Received: 26 May 1998/Accepted: 30 June 1998     

Immunolocalization of the components of the plasminogen activating system in breast carcinoma tissue

The plasminogen activating system plays an important role in the progression of carcinomas and the significance of this system in various carcinomas has been thoroughly investigated. To follow up these investigations, we examined the immunolocalization of the components of the plasminogen activating system, namely the urokinase-type plasminogen activator (uPA), its receptor (uPAR), and two inhibitors (PAI-1 and PAI-2), in 72 cases of breast carcinomas. uPA, uPAR and PAI-1 were uniformly expressed in 75.0%, 84.7% and 80.6% of the cases respectively, although their expression was less uniform in T3 or larger carcinomas (p<0.05). Furthermore, the immunoreactivities of these three proteins were often very similar in the lesions. PAI-2 expression was, to the contrary, statistically less extensive (p<0.01)than PAI-1, and only 52.8% of the cases were uniformly positive. The incidence of PAI-2 expression was statistically lower in T3 or larger carcinomas (p<0.01), and in stage III (p<0.01) and grade III carcinomas (p<0.05). Moreover, PAI-1 immunoreactivity was more commonly found in lymph node positive (p<0.05), T3 or larger and stage III carcinomas than PAI-2 immunoreactivity. These findings suggest that uPA, uPAR and PAI-1, whose expression should be regulated by carcinomas once they have grown to a certain degree, work in association with one another, probably promoting carcinoma progression, while PAI-2 might act as the inhibitor in this system. Furthermore, breast carcinomas containing more PAI-I than PAI-2 are more active in respect to both local proliferation and metastasis.     

High incidence of p53 gene mutation in human ovarian cancer and its association with nuclear accumulation of p53 protein and tumor DNA aneuploidy.

Using the polymerase chain reaction and single-strand conformation polymorphism analysis, p53 gene mutations were examined in 24 cases of ovarian tumor including 14 ovarian carcinomas and 2 borderline cases of common epithelial type, 7 germ cell tumors, and one stromal tumor. Abnormal bands indicating mutations were detected in 12 (50%) of the cases examined, being present most frequently in common "epithelial" ovarian carcinoma (71%, 10/14). One case each of squamous cell carcinoma originating in a dermoid cyst and anaplastic dysgerminoma were positive for mutation. Direct sequencing confirmed 12 mutations and revealed G-->A and G-->C nucleotide changes in 5 and 3 cases (42% and 25%), respectively. The mutation was localized at the CpG site of the gene in 3 cases. Immunohistochemical examination of p53 protein in 21 cases and DNA flow-cytometrical analysis in 17 cases were also performed. Nuclear accumulation of the p53 protein and DNA aneuploidy pattern were detected in 11 (52%) and 9 (53%) cases, respectively. These were significantly correlated with p53 gene mutation (P < 0.01 and P < 0.05, respectively; Fisher's exact test). Neither mutation of the p53 gene, nuclear accumulation of p53 protein nor DNA aneuploidy was detected in borderline cases of common "epithelial" type, typical dysgerminoma and immature teratoma. These results suggest that p53 gene mutation, nuclear accumulation of the protein and the DNA aneuploidy pattern are events occurring almost simultaneously in the progression of ovarian tumors, and that p53 abnormalities seem to be correlated with a high grade of malignancy.     

Evaluation of high-frequency jet ventilation in oxygenation through an artificial membrane lung

The membrane oxygenator often develops impaired gas exchange after prolonged use because plasma proteins adhere to the membrane's surface and leak through its micropores. This study was performed to examine the efficacy of high-frequency jet ventilation (HFJV) in minimizing these problems in a "flat plate" type of membrane oxygenator. We first vibrated the membrane of the oxygenator by HFJV from 1 to 10 Hz to find the frequency most effective for optimal gas exchange in animals with partial extracorporeal circulation. These studies suggested that 6 Hz HFJV was preferable in our model. We subsequently performed in vivo extracorporeal oxygenation in dogs for 8 h using the membrane oxygenator with or without 6 Hz HFJV. Although the gas exchange capacity within the first 8 h was similar in the two groups, after 6 h a significant decrease in the red blood cell count and in the hematocrit was found in the group not receiving HFJV. Scanning electron microscopic examination of the membranes after 8 h of use disclosed that the membrane from the group receiving HFJV had less plasma protein and fibrin adhesion than that from the group not receiving HFJV. Moreover, it appears that with prolonged extracorporeal oxygenation, 6 Hz HFJV also protects against a decrease in the hematocrit of the passed blood and might lead to enhanced gas exchange. Our data suggest that good gas exchange can be maintained for periods even longer than 8 h if HFJV is used in conjunction with the membrane oxygenator.     

Entry: a new approach

Despite all of the protections promised through grandfathering and pathways to educational mobility, the entry movement tends to be perceived by many to be "demoting" the lives and livelihoods of hundreds of thousands of RNs who do not possess the education to meet the proposed standard. Here is a proposal for a way out of the quagmire.     

Hemodynamic response to dietary sodium loading in essential hypertension studied with Doppler echocardiography

The cardiac response to dietary salt loading was assessed by Doppler echocardiography during various sodium intakes (52-345 mEg per day) in 30 patients with essential hypertension. The Mitral flow velocity integral in the rapid filling phase (IntR) and the atrial contraction phase (IntA) was measured from the transmitral flow pattern, and the sum of IntR and IntA (IntR + IntA), the ratio of IntA to IntR (IntA/IntR), cardiac output (CO) and total peripheral resistance (TPR) were calculated. With salt loading, the mitral flow pattern remained almost unchanged in the nonsalt-sensitive (NSS) patients. Fourteen of the 19 salt-sensitive (SS) patients showed significant increases in IntR + IntA and CO with salt loading (IntR + IntA, from 13.9 +/- 2.8 to 17.9 +/- 3.6 cm, p less than 0.01; CO, from 6021 +/- 2130 to 8305 +/- 1699 ml/min, p less than 0.01), and were termed "salt-sensitive CO-dependent" (SS [COdep]), suggesting that the apparent pressor response to sodium loading was mediated by an increased CO. In the remaining five SS patients termed "salt-sensitive CO-independent" (SS [COindep]), IntA/IntR increased significantly with sodium repletion (from 0.66 +/- 0.23 to 0.90 +/- 0.31, p less than 0.01), without a significant change in IntR + IntA. Increments in IntA/IntR observed in the SS [COindep] patients were considered to be due to an elevation of total peripheral resistance (TPR), since changes in IntA/IntR were significantly correlated with those in TPR in all subjects (r = 0.617, p less than 0.01).