Chemical modification of superoxide dismutase Extension of plasma half life of the enzyme through its reversible binding to the circulating albumin

Protection of organisms from oxidative stress is one of the major prerequisites for aerobic life. Since intravenously injected Cu⁺⁺/Zn⁺⁺ -type superoxide dismutase (SOD) rapidly undergoes renal glomerular filtration and appears in urine in its intact form, its clinical use as a scavenger for superoxide radicals has been highly limited. To test whether reversible interaction of SOD with plasma albumin might decrease the rate of disappearance of the enzyme from the circulation, the lysyl residues of the human erythrocyte-type enzyme were covalently linked with poly-(styrene-co-maleic acid) butyl ester (SMA) via amide linkage. Affinity chromatographic analysis by an albumin-Sepharose column revealed that the enzyme samples labeled with SMA (SMA-SOD) tightly bound to the column, while unmodified SOD was eluted in the unbound fractions. SMA-SOD bound to the column could be eluted by the buffer solution containing 0.1% sodium dodecylsulfate. In vivo analysis revealed that intravenously administered SMA-SOD circulated bound to albumin with an extremely long half-life (6 h), while unmodified SOD rapidly underwent renal glomerular filtration with a plasma half-life of 4min. Thus, SMA-SOD may effectively dismutate superoxide radicals in the circulation.     

A Clinical and Experimental Study on Longitudinal Deficiencies in Lower Limbs in Relation to Pathogenesis of Cleft Foot

Abstract In order to determine whether cleft foot is caused by the same mechanism as tibial and fibular ray deficiencies, clinical cases of these anomalies and those in rat fetuses induced by myleran were analyzed. In tibial and fibular ray deficiencies, arrest of tibia or fibula was closely related to the missing of toes and tibial and fibular ray deficiencies can be accepted as an occurrence of so called longitudinal deficiency. On the other hand, cleft feet were frequently associated with central Polydactyly and syndactyly. In our experimental study, the critical period of formation of cleft foot was different from that of tibial ray deficiency, but it was similar to those of central Polydactyly and syndactyly. It seems that cleft foot is caused by the abnormal induction of toe rays as in cleft hand and does not belong to the same group as tibial and fibular ray deficiencies.     

Incremental Value of Objective Frailty Assessment to Predict Mortality in Elderly Patients Hospitalized for Heart Failure

Background

The impact of frailty on long-term prognosis in patients with heart failure (HF) remains unclear, and there is no simple and objective assessment for it. This study was performed to examine the association between frailty score and clinical outcome in elderly patients hospitalized for HF.

Electrophysiological Characteristics of Localized Reentrant Atrial Tachycardia Occurring After Catheter Ablation of Long-Lasting Persistent Atrial Fibrillation

Background: Mapping of recurrent atrial tachycardia (AT) after extensive ablation for long-lasting persistent atrial fibrillation (AF) is complex. We sought to describe the electrophysiological characteristics of localized reentry occurring after ablation of long-lasting persistent AF.
Methods: Out of 70 patients undergoing catheter ablation of long-lasting persistent AF, 9 patients (13%, 55 ± 8 years, 8 males) in whom localized reentry was demonstrated in a repeat ablation were studied. Localized reentry was defined as reentry in which the circuit was localized to a small area and did not have a central obstacle. The mechanism of AT was determined by electroanatomical and entrainment mapping.
Results: Nine localized reentries with cycle length of 243 ± 41 ms were mapped in 9 patients. The location of AT was the left atrial appendage in 4 patients, anterior left atrium in 2, left septum in 2, and mitral isthmus in 1. In all ATs, a critical isthmus of <10 mm in width was identified in the vicinity of the prior linear lesions or ostia of isolated pulmonary veins. Ablation of the critical isthmus, which was characterized by continuous low-voltage activity (median voltage: 0.15 mV, mean duration: 117 ± 31 ms), terminated AT and rendered it noninducible. Additionally, ablation was performed for all of inducible ATs. At 11 ± 7 months after the procedure, 8 of 9 patients (89%) were free from any arrhythmias.
Conclusions: After ablation of long-lasting persistent AF, localized reentry may arise from a site in the vicinity of the prior ablation lesions. Ablation of the critical isthmus eliminates the arrhythmia.     

Clinical Features of Congenital Ankylosis of the Digital Joints of the Hand

ABSTRACT: Clinical features and roentgenographic findings of 37 patients (65 hands) with congenital ankylosis of the digital joints, including symphalangism and other types of congenital ankylosis of the joints, were analyzed. Congenital ankylosis of the digital joints was divided into four types according to the clinical features as follows; Type A (typical symphalangism), 13 cases, Type B (symphalangism without associated anomalies), 6 cases, Type C (symphalangism associated with hypoplasia of the affected digit), 10 cases and Type D (symphalangism as a part of syndrome), 8 cases. Roentgenographic findings of the affected joints were divided into 4 types, such as normal type (Type I), narrow type (Type 2), flat type (Type 3) and bony ankylosis (Type 4). There seems to be 4 types of joint development in congenital ankylosis of the digital joints. In Types 1 and 2, the joint space of the affected joint and the secondary ossification center looks normal. The joint seems to develop normally in Type 1, but the condyle of the affected joint becomes flat in Type 2. In Type 3, the joint space is narrow in infancy, the secondary ossification center fuses with the proximally located phalanx and finally the affected joint develops bony ankylosis. In Type 4, there is osseous fusion of the affected joint at birth. Key words: hand, joint, symphalangism, tarsal coalition, carpal coalition     

Minute Rectal Cancer Associated with Nodular Involvement —A Case Study—

Abstract: This study presents the case of a patient with minute type Ha rectal cancer with a diameter at its largest of only 5 mm, with infiltration as far as the submucosal layer (sm) and positive parietal lymph node metastasis. The patient was a 54 year-old male who visited Yasuda Medical Hospital because of diarrhea which appeared in early May 1988. During sigmoidscopy, a small protruding lesion was seen in the rectum (Rs) about 12 cm from the margin of the anus, and the patient was referred to the authors' surgical service for an endoscopic polypectomy because of a biopsy diagnosis of adenocarcinoma. The polyp had a smooth, shiny surface, and had a well demarcated hemispherical shape. A histopathological examination of the polypectomized specimen, showed that it was an invasive carcinoma extending into the submucosal layer without any adenoma component. Since the cut end of the specimen strongly suggested positive cancer cells and lymphatic permeation was also confirmed from the polypectomized specimen, a low anterior resection was performed on August 4, 1988. The postoperative histological examination revealed a small amount of residual cancer cells in the submucosal layer which appeared to be at the cut end of the resected polyp. One metastatic focal point was seen in the pararectal lymphnode, and this patient's case provided valuable suggestions for deciding upon therapeutic policies for early cancer of the large intestine.     

Changes of QRS axis in transient myocardial ischaemia induced by percutaneous transluminal coronary angioplasty

The QRS axis of 130 consecutive patients with coronary arterydisease undergoing percutaneous transluminal coronary angioplasty(PTCA) were measured before balloon inflation and just beforeballoon deflation. Patients were divided into two groups. GroupA (103) had angina pectoris and/or non-transmural old myocardialinfarction with no abnormal Q waves; group B (27) had an oldtransmural myocardial infarction with abnormal Q waves. In groupA, the QRS axis had significantly shifted to the left in patientswith left anterior descending artery (LAD) occlusion (from 68.0± 42.7^° to 40.2 ± 44.6^°, P<0.001);however in those patients without involvement of the major septalbranch, significant axis changes were not observed (from 53.6± 34.1^° to 49.8 ± 33.1^°). When the rightcoronary artery (RCA) was occluded in group A, the QRS axisshifted to the right significantly (from 63.2 ± 40.0^°to 89.8 ± 30.1^° P<0.01); during left circumflexartery (LCX) occlusion, no significant axis shift was observed.In group B, no significant axis shift was observed either inpatients with occlusion of the LAD or the RCA. It is concludedthat transient left axis deviation reflects an obstructive lesionof the proximal portion of the LAD with involvement of the majorseptal branch, and transient right axis deviation reflects anobstructive lesion of the RCA.     

The curative role of radiotherapy in patients with isolated para-aortic node recurrence from cervical cancer and value of squamous cell carcinoma antigen for early detection

The objective of this study was to examine the clinical benefits of routine squamous cell carcinoma antigen (SCC-ag) monitoring of patients with locally advanced cervical cancer. Recurrent disease occurred in 99 uterine cervical cancer patients with elevated pretreatment SCC-ag before primary radiotherapy. Elevated SCC-ag levels persisted in 23 patients after primary radiotherapy (group 1), and SCC-ag was normalized in 76 patients after primary radiotherapy (group 2). The overall survival (OS) rate was higher for patients with SCC-ag elevation as the first sign than for patients with recurrence predicted by other modalities for group 2 patients (P = 0.033). The prediction of isolated para-aortic node recurrence significantly correlated with SCC-ag elevation as an initial sign (P = 0.001). The SCC-ag level before primary radiotherapy (> or = 10.8 ng/mL) significantly affected recurrence predicted by SCC-ag elevation as an initial sign (P = 0.002). For multivariate analysis, the presence of para-aortic node recurrence was statistically significant in OS (P < 0.0001). Routine SCC-ag monitoring of patients with carcinoma of the uterine cervix can lead to the early diagnosis of isolated para-aortic lymph node recurrence, and prolonged survival can be achieved by applying radiation therapy to the para-aortic region. To reduce the number of patients monitored for SCC-ag, we recommend monitoring group 2 patients with pretreatment SCC-ag level before primary radiotherapy > or = 10.8 ng/mL.     

Total Reconstruction of the Auricle in Unilateral Microtia*

ABSTRACT In the 10 years from 1973 to 1982, 537 microtia patients visited to our Department. the operation is usually started around the age of ten years. We have used to reconstruct the auricle consists of two stages. To transplant the cartilage framework, the subcutaneous pocket is made from the incision line for the switching of the auricular remnants. The thickness of the skin layer in this pocket was selected to correspond to a depth immediately below the subdermal plexus. The skin of the auricular area is fitted closely to the transplanted cartilage framework by several mattress sutures tied over gauze. After transplanting the framework, it is of paramount importance for achieving a well-shaped prominence for the helix and anthelix to ensure that no excessive stress is brought to bear from the outside of the article. For this purpose, we used a thick Reston Sponge (3M Co., Ltd.) with a hole provided in the middle and stuck in onto the auricle. About six months after the first stage operation, the transplanted framework is raised from the side of the head with its overlying skin, in one stage. The skin flaps A and B are prepared at the upper and lower parts of the root of the auricle. These two flaps are transferred along the auriculocephalic sulcus toward the posteromedical auricular surface and sutured with 4-0 nylon mattress sutures. The raw area left event after this, a full thickness skin graft taken from the abdominal region is transplanted.