Purification and characterization of photosensitizing hemolytic toxin from harmful red tide phytoplankton, Heterocapsa circularisquama

We have previously found that the methanol extract prepared from Heterocapsa circularisquama, a harmful red rid dinoflagellate, showed light-dependent hemolytic activity toward rabbit erythrocytes. Interestingly, the cytotoxicity of the extract against HeLa cells was also strictly light-dependent, and no significant toxic effect was observed even at very high concentration in the dark. In this study, the hemolytic agents present in the extract were purified by several chromatographic procedures. Final HPLC analysis revealed that there are at least two hemolytic toxins with different retention times (H2-a and H3-a), which have similar absorption spectra. Although H3-a fraction was contaminated by a trace amount of H2-a, H2-a fraction gave a single peak on a three-dimensional chromatogram. The results of fast atom bombardment (FAB)-mass spectrometry (MS) and electrospray ionization quadrupole time-of-flight (ESI Q-TOF) mass spectrometry analyses suggested that the molecular weight of H2-a was 566. Since nuclear magnetic resonance analysis indicated the presence of a pyrrole ring in H2-a molecule, H2-a may be a porphyrin derivative with similar structure of pyropheophorbide a methyl ester, a well-known photosensitizing hemolytic compound. However, some structural and physicochemical differences were observed between H2-a and pyropheophorbide a methyl ester. Since H2-a showed potent photosensitizing cytotoxicity toward HeLa cells in a concentration-dependent manner as well as hemolytic activity, H2-a may be a novel porphyrin derivative with photosensitizing hemolytic cytotoxicity.     

Interferon-based cytokine therapy for advanced renal cell carcinoma

Among 126 patients diagnosed with metastatic renal cell carcinoma at Hamamatsu University or its affiliated hospital between 1978 and 2004, pretreatment features associated with a shorter survival in the multivariate analysis were in symptomatic status at diagnosis and in multiple organ metastasis. The 1- and 3-year survival rate in patients with these two prognostic factors were 22.3 and 0.3%, respectively. The style of treatment did not influenced survival in these patients. Therefore, an accurate assessment of their survival benefits both them and physician while it is urgent that we develop novel agents and strategy.     

Anesthetic management of a patient undergoing PTA stent placement for right common carotid artery stenosis

A 60-year-old man underwent percutaneous transluminal angioplasty (PTA) stent replacement of the right common carotid artery. Preoperative angiogram revealed bilateral vertebral artery occlusion and 50% stenosis in contralateral internal carotid artery. Anesthesia was induced and maintained with fentanyl and propofol by TCI. rSO2, BIS and EEG were monitored. Moderate hypothermia (33-35 degrees C) was induced by concomitant use of milrinone. Edaravone, a novel free radical scavenger, and Sendai cocktail were administered before interruption of carotid flow. During 5 minutes of test occlusion by balloon, right rSO2 decreased from 61% to 49% and EEG showed slow waves with decreased amplitude. Therefore we decided to perform PTA and stenting separately. Right rSO2 decreased from 62% to 48% during PTA (6 min occlusion), while rSO2 decreased from 66% to 50% during stenting (7.5 min occlusion). EEG also showed the similar changes as observed during test occlusion. After the procedures, rSO2 and EEG recovered in a short time. Postoperative angiogram showed an improvement of carotid artery stenosis and intracranial vessels showed no branch occlusion. Patient was maintained hypothermic (35 degrees C) for 2 days after surgery. He recovered without additional neurological complications. We found that rSO2 was a useful, real-time and non-invasive method for evaluation of cerebral ischemia in our patient.     

A case of thoraco-amniotic shunt for congenital cystic adenomatoid malformation

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary anomaly, which may lead to fetal hydrops, pulmonary hypoplasia, and fetal or neonatal death. Recently, diagnosis and surgery for fetus have been improved. We experienced a case of CCAM, classified in Stocker class I, with a single cyst of about 5 cm in diameter. A 32 year-old pregnant woman had a fetus diagnosed as CCAM at 25 th gestational week. The thoraco-amniotic shunt placement using a modified double pig tail catheter was performed at 27 th gestational week under general anesthesia with 1% isoflurane in oxygen 2 l x min(-1) and nitrous oxide 4 l x min(-1), and 100 microg of fentanyl. Fetal movement was suppressed during surgery. This fetal therapy was effective and the cyst disappeared after surgery. The baby was delivered with caesarian section under spinal anesthesia with 0.5% bupivacaine 2.5 ml. On the next day, right lung lobectomy was accomplished under general anesthesia with fentanyl 0.2 mg and pancuronium 6.0 mg. Anesthesia with isoflurane, nitrous oxide, and fentanyl was useful for the fetal surgery of thoraco-amniotic shunt placement. Consequently, caesarian section and lung lobectomy were completed successfully.     

Assessment of English literatures evidence toward the development of clinical guidelines for elderly patients with lung cancer

The purpose of this study is that we propose the clinical practice guidelines for elderly patients with lung cancer in Japan. The results and conclusions are as follows: 1) As pneumonectomy in patients over the age of 70 carries a considerable risk of severe postoperative morbidity and mortality, it should be avoided. 2) Although it is no significant differences between 3 groups (age < 70, 71-79, 80 < or =) in the 30 days mortality rates, less invasive surgery decrease them. 3) Age is not the important prognostic factor, however, operative procedure should be choose over the estimation of surgical risk and the potential long-term benefit.     

High-grade congenital esophageal stenosis owing to a membranous diaphragm with tracheoesophageal fistula

Gross E-type congenital esophageal atresia associated with congenital esophageal stenosis is extremely rare. In a male infant born at 36 weeks of gestation, bubbly vomiting was noted after birth. X-ray films of the chest and abdomen showed coil-up sign of the nasogastric tube and gas in the stomach and small intestines were recognized, so gross C-type esophageal atresia was suspected and surgery was performed on the first day of life. Surgery revealed the presence of a tracheoesophageal fistula in the upper esophagus and membranous stenosis on the distal side.     

A novel molecular marker of pituitary tumor transforming gene involves in a rat liver regeneration

BACKGROUND: Pituitary tumor transforming gene (PTTG), homologous to a mammalian securin, plays a pivotal role in cell transformation, however, its biological function(s) in normal tissues is not fully understood. Because the liver is a regenerative organ, the relevant biological function of PTTG in the liver would be more feasible to understand PTTG. Also, PTTG may be involved in the liver regeneration. MATERIALS AND METHODS: Expressions of rat hepatic PTTG messengerRNA (mRNA) and cellular immunoreactivities during the cell proliferative period of the liver regeneration both in vitro and in vivo were tested. RESULTS: PTTG expression of the rat primary hepatocyte was stimulated by HGF in a dose dependent manner, and was suppressed when hepatocyte proliferation was inhibited by transforming growth factor-beta1. A positive PTTG immunoreactive co-localizing with 5-bromo-2'-deoxyuridine (BrdU) in the hepatocyte nucleus was found and there was a concurrent sister chromatin itself by the immunofluorescent labeling of PTTG with cytokeratin 18 (CK18). DISCUSSION: Since the correlation of PTTG mRNA expression, cell proliferation and immunoreactivity were observed in primary rat cultured hepatocytes, PTTG may be a novel marker of cell proliferation both in vitro and in vivo liver regeneration.     

The standardization of pancreatic donors for islet isolations

BACKGROUND: Islet transplantation has proven to be a successful treatment for type 1 diabetes mellitus. The aim of this study was to establish an algorithm by which the combination of the donor quality and pancreas quality was given a numerical score from 0 to 100 for use in determining the quality of a pancreas for islet isolation. METHODS: We retrospectively analyzed 326 pancreases and the outcomes of their respective isolations. Specific donor variables and physical characteristics were identified and weighted according to their influence on the success of the isolation. For each variable, ranges and point weightings were established based on our laboratory experience and literature review. RESULTS: Analysis of the data showed a strong association of the donor point with isolation outcome. Pancreases with lower donor point scores had lower transplant success rates, whereas higher donor point scores in turn produced higher transplant rates. CONCLUSIONS: This scoring system has proven to be useful in guiding the decision process as to whether to accept a particular pancreas for a favorable isolation outcome.     

Vascular reconstructive surgery for elderly patients with internal carotid artery stenosis at the cervical portion

PURPOSE: We encounted increasing numbers of elderly patients suffering from stenotic lesions of the cervical internal carotid artery. Most of them have been considered to indicate a need for carotid artery stenting. The purpose of this study was to clarify with regard to the modality of treatment and perioperative complications the effectiveness of vascular reconstruction procedure in elderly patients. PATIENTS AND METHODS: Ninety eight lesions in 91 patients with stenosis of the internal carotid artery were treated surgically. Eighty lesions received carotid endarterectomy (CEA), and 18 lesions received percutaneous transluminal angioplasty (PTA) with or without stent. Treatment with PTA-with-or-without-stent has been opted in cases of patient with such conditions as radiation-induced stenosis, re-stenosis after CEA, unfitness for general anesthesia, bilateral lesions both of which need to be reconstructed with in a short interval. We divided the patients into 4 groups according to their age; under 70-year-old group, 70-to-74-year old group, 75-to-79-year old group, and over 80-year-old group. Vasoreconstructive procedures were performed for 41 patients in the under 70-year-old group, for 31 in the 70-to-74-year old group, for 21 in the 75-to-79-year old group, and for 5 in the over 80-year-old group. RESULT: The overall surgical morbidity rate was 2% (2 of 98 cases) and there was no mortality. Tweleve patients (12.2%) experienced transient neurological deficits. Two patients exhibited perioperative complications in gastrointestinal organs, but none of the patients experienced cardiac complications. Elderly patients tend to experience systemic complications such as gastrointestinal complications as well as transient neurological deficits, which appear as restlessness, possibly due to hyperperfusion syndrome. The perioperative complication rate in elderly patients (putting the patients of the 70-to-74-year old group, the 75-to-79-year old group, and the over 80-year-old group together) was, statistically, significantly higher than those in patients of under the 70-year-old group. However, when two treatment modalities, CEA and PTA-with-or-without stent, were compared, there was no significant difference in the perioperative complication rate. CONCLUSION: Careful patient selection and prudent perioperative management enabled us to perform vasoreconstructive surgery even for elderly patients with internal carotid artery stenosis in a relatively safe manner with an acceptable complication rate. Decision making in selecting treatment modality, CEA or PTA with or without stent, should not be based solely on aging.