Aortic dissection complicating cardiac surgery in a patient with calcified ascending aorta

Aortic dissection is a rare but devastating complication of cardiac surgery. Adequate and early diagnosis of intraoperative aortic dissection and quick therapeutic decision making are the keys for saving patients in such cases. We describe the case of a 68-year-old man referred for CABG and mitral valve replacement with severe calcification of the ascending aorta. Intra-operative transesophageal echocardiography was useful for diagnosis of intra-operative aortic dissection and malperfusion of the true lumen. Immediate switching of the arterial perfusion site established flow in the true lumen with prompt subsidence of the expanded false lumen. CABG, mitral valve replacement and graft replacement of the ascending aorta could be simultaneously performed in this patient.     

Prognostic significance in malignant melanoma of nuclear DNA content measured by a microfluorimetric method

The nuclear DNA content of 47 primary malignant melanomas was measured by 4,6-diamidino-2-phenylindole-DNA (DAPI-DNA) microfluorimetry, and the DNA index, a quantitative measure of nuclear DNA content, was calculated. The DNA index and other clinical and pathological variables were examined and compared with patient survival using univariate and multivariate analyses. The Kaplan-Meier life table method revealed that the DNA index and metastases to regional lymph nodes significantly correlated with patient survival. A Cox proportional hazards multivariate analysis demonstrated that the DNA index, which was not significantly correlated with other variables, was the most reliable and independent factor for predicting patient survival.     

Essential metals and metallothionein in cadmium-induced thymic atrophy and splenomegaly

Cadmium chloride was injected intraperitoneally into mice and the animals were sacrificed 1, 3, and 9 days after the injection. The concentrations and contents of cadmium and six essential metals in the thymus, spleen, kidney, and liver were determined by inductively coupled plasma-atomic emission spectrometry. Although the accumulation of cadmium in the thymus and spleen was as low as 0.05 and 0.2–0.4% of the injected dose, respectively, compared to liver (60%) and kidney (6.5–9.0%), the two immune organs showed dramatic changes of weights; namely severe atrophy of thymus and enlargement of spleen. The concentrations of zinc in the two immune organs did not change during the atrophy or enlargement, though the contents showed significant decrease or increase dependent upon the changes in weights. The concentrations and/or contents of other essential metals also changed with time and the changes depended on organs. The distributions of cadmium in the supernatant fractions of thymus and spleen were determined by high speed liquid chromatography with a flame atomic absorption spectrophotometer. Two cadmium peaks which correspond to the two isometallo-thioneins were eluted exactly at the same retention times as those of liver metallothioneins.     

GENERALIZED HERPES SIMPLEX

A 41-year-old Japanese man with a 11-year history of Hailey-Hailey's disease on his groin developed generalized herpes simplex on his groin, throat, lips and extremities which, to our knowledge, has not been previously described. Histological examinations using light and electron microscopes showed herpes virus infection of the skin. Virus culture and serological methods revealed this case to be a primary infection of type 1 herpes simplex virus.     

COMPARATIVE STUDIES ON THE PREVENTIVE EFFECT OF PYRIDINOLCARBAMATE AND ESTROGEN AGAINST AORTIC AND CORONARY ATHEROSCLEROSIS OF CHOLESTEROL-FED RABBITS

The antiatherosclerotic effects of pyridinolcarbamate and estrogen, both of which have a preventative effect against acute edematous vascular injury, were studied using 40 rabbits. Ten rabbits each received orally 0.1 mg/kg or 1 mg/kg of diethylstilbestrol, 10 mg/kg of pyridinolcarbamate or potato starch as a placebo. All were fed cholesterol for 15 weeks. Treatment with pyridinolcarbamate of 1 mg/kg of diethylstilbestrol was shown to exert a powerful effect in preventing the appearance of atheromatous changes (p<0.01) but 0.1 mg/kg of diethylstilbestrol did not show a preventative effect. The three treated groups exhibited protection against coronary atherosclerosis which was statistically significant when compared with the controls. Atheromas in rabbits treated with pyridinolcarbamate were characterized his-tologically by the regeneration of smooth muscle fibers and those treated with diethylstilbestrol by fibrous healing. Necrotic foci or calcification was sometimes encountered, especially in the rabbits treated with 1 mg/kg of diethylstilbestrol. These preventative properties of the substances studied are possibly much related to inhibit permeability-enhancing conditions of the arterial wall.     

Garcin syndrome in a patient with rhinocerebral mucormycosis]

Garcin syndrome is characterized by an unilateral cranial nerves involvement without sensory or motor long-tract disturbances. It is usually caused by tumor infiltrating in the skull base with osteolytic changes on radiological study. We report a case of 64-year-old man with history of alcohol overintake, who admitted local hospital, because of right periorbital edema and facial swelling. He noted right ptosis 2 weeks prior to admission. Neurological examination revealed right multiple cranial nerves involvement including II, III, IV, V, and VI cranial nerves. MR imaging of the brain showed marked paranasal sinusitis and abnormal infiltration of right orbital fat. Orbital apex syndrome related to paranasal sinusitis was diagnosed, and antibiotics was administered. But a few days after admission, he developed a right VII, IX, X cranial nerve palsy. He was transferred to our hospital because of acute development of left hemiparesis and deteriorated consciousness. MR imaging of the brain showed right internal carotid artery (ICA) occlusion, and infarction in right middle cerebral artery (MCA)'s territory. The diagnostic biopsy of the paranasal sinus showed mucorales hyphae, indicating that the pathological diagnosis was mucormycosis. Despite of antibiotic therapy included of amphotericin-B administration and strict control of diabetic mellitus, his sinusitis was gradually spread. His condition progressively deteriorated, and finally died of sepsis. Post-mortem examination revealed a widespread mucor infiltration in the dura mater without skull bone invasion. This case presented with unilateral multiple cranial nerve involvements (Garcin syndrome) followed by left hemiparesis associated with rhinocerebral mucormycosis. It is suggested that mucormycosis should be considered in case of Garcin syndrome without osteolysis in the skull base.     

Antiviral and Interferon-Inducing Activity of a New Glutarimide Antibiotic, 9-Methylstreptimidone

The antiviral effect of 9-methylstreptimidone (9-MS) was examined in mice infected with mouse-adapted influenza A₂ (H₂N₂) virus. Both a single and continuous prophylactic administration of 9-MS protected mice from virus infection, and comparison between the minimal effective and the 50% lethal dose gave a therapeutic index of 60. When the treatment was started after infection, however, no antiviral effect was demonstrated. After a single intraperitoneal administration of 9-MS, a highly potent virus-inhibitory factor was detected in the lungs (10 h later) and the sera (16 h later) of uninfected mice, which was assumed to be an interferon on the basis of the biological characteristics. These results suggest that the protective activity of the antibiotic is due to interferon induction in mice.     

High-density culture of mouse Meckel's cartilage cells stimulates phenotypic conversion to osteocyte-like cells

We examined the influence of cell density on the phenotypic conversion of Meckel's cartilage cells. The cells were isolated by enzymatic digestion and plated at a density of 0.5 × 10⁴ or 2 × 10⁴ cells/penicylinder and cultured under 5% CO₂ in air for up to 4 weeks. The cultures were analyzed histologically by electron microscopy, histochemistry, and immunostaining. At the early stage of high-density culture, metachromatic chondrocytes appeared concomitantly with cartilage-specific type II collagen synthesis. The cells gradually transformed from large polygonal cells to multilayered small round cells, and formed nodules. During the later stage of culture, the cells exhibiting alkaline phosphatase (ALPase) activity, type I collagen, and osteocalcin as bone-type marker proteins consisted of spindle-shaped cells showing phenotypic conversion into osteocyte-like cells in the calcified nodules. In contrast, during low-density culture, most of the cells changed from fibroblastic cells to large flattened cells without cellular nodule formation, but these cells lacked chondrocytic features. Only solitary cells exhibited chondrocyte-specific features such as metachromasia, proteoglycan synthesis, and matrix calcification, but they did not undergo osteocytic transdifferentiation. These results indicate that well-organized nodule-forming cellular and extracellular components in high-density culture stimulate transdifferentiation into osteocyte-like cells.