Effects of Partial Left Ventriculectomy on Left Ventricular Pump Function Studied by Theoretical Analyses

Although partial left ventriculectomy (PLV) was devised to reduce myocardial wall stress in patients with severe heart failure, whether the operation acutely improves cardiac pump function has not been determined either clinically or experimentally. Because precise control of preload, afterload, and heart rate is virtually impossible in animal experiments as well as clinically before and after surgery, we took advantage of the theoretical analysis to study quantitatively the changes in pump function by PLV. We reconstructed the endsystolic and end-diastolic pressure-volume relationships based on two different geometric conditions (i.e., before and after volume reduction) but from the same myocardial stress-strain relationship. The effect of volume reduction surgery on left ventricular pump function depended on preoperative conditions. We found that the improvement in pump function was achieved only if elastance (Ees) was low and if the end-systolic strain-axis scaling parameter (k) value was low. The presence of hypertrophy amplified the improved function, but again with low Ees and low end-systolic k. We conclude that the favorable hemodynamics are expected only in limited cases during the acute phase. Candidates for favorable preoperative factors include low end-systolic Ees, an end-systolic pressure-volume relationship being less convexed toward the volume axis (low k), and large left ventricular mass.     

Effect of streptozotocin-induced diabetes mellitus on the pharmacokinetics of nelfinavir in rats

The HIV protease inhibitor, nelfinavir (NFV), has been used widely for HIV infection. The drug exhibits high binding characteristics to serum protein (unbound fraction: 0.01). The effect of experimentally induced diabetes mellitus on the pharmacokinetics of NFV was investigated, focusing on the change of protein-binding due to the glycosylation of albumin in streptozotocin-induced diabetes mellitus rats (diabetic rats). The unbound fraction of NFV in diabetic rats (0.04) was greater than that in the control (0.015). In diabetic rats, although the AUC of NFV was decreased after both intravenous (control: 1.75±0.08, diabetic: 1.36±0.17 µg h/ml) and intraduodenal (control: 1.69±0.25, diabetic: 1.19±0.39 µg h/ml) administrations, the unbound AUC was increased significantly (intravenous, control: 0.026±0.001, diabetic: 0.054±0.007 µg h/ml, intraduodenal, control: 0.025±0.004, diabetic: 0.048±0.016 µg h/ml). The unbound total clearance (control: 131.3±6.0, diabetic: 64.3±8.0 l/h/kg) and the unbound steady state distribution volume (control: 274.0±18.0, diabetic: 123.0±14.0 l/kg) were decreased significantly; therefore, greater pharmacological effects can be expected in diabetes mellitus. The contribution of increasing the unbound fraction to these results was significantly higher. In addition, there were no significant differences in the systemic and hepatic availability, peak time and mean absorption time between the diabetic and control rats, suggesting that diabetes mellitus did not affect the absorption of NFV. Copyright © 2008 John Wiley & Sons, Ltd.     

Long-term surviving patients with hepatocellular carcinoma comprised of dense collagenous stroma

In two patients with hepatocellular carcinoma (HCC), treated surgically, we observed a dense collagenous stroma not heretofore reported. Grossly, the tumors consisted of a broad area of dense collagenous stroma that embedded the nodules of the HCC. Microscopically, nodules of the cancer cells were widely separated by this dense fibrous stroma, in association with surrounding inflammatory infiltrates, composed mainly of lymphocytes. These two patients had lived, respectively, for 10 yr and 2 months, and 8 yr and 9 months, despite precarious clinical states. HCC with characteristics such as a grossly distinct dense collagenous stroma and an inflammatory infiltrate may relate to a distinct category with a favorable prognosis.     

Prevalence of Chlamydophila pneumoniae among Bangladeshi children under age 5 years with acute respiratory infections

Despite major improvements in the diagnosis of pathogenic organisms causing acute respiratory infections (ARIs), details of infections caused by atypical pathogens are not well understood, particularly in developing countries. This clinical and epidemiological research was conducted in Bangladesh to explore the prevalence of atypical pathogens in causing childhood pneumonia. Sixty-four children with ARI were studied at the Pediatric Outpatient Department of Dhaka Medical College Hospital, Bangladesh, during September through December 2000. In addition to clinical examination, hematological, radiological, and bacteriological examinations were performed. Antibody titers from paired sera against Mycoplasma pneumoniae and Legionella spp. in the acute and convalescent phases revealed that none of these children were infected with M. pneumoniae, while only one serum sample was positive for L. pneumophila serogroup 4. Antibody titers against Chlamydophila (Chlamydia) pneumoniae, determined by an indirect microimmunofluorescence method, and by an enzyme-linked immunosorbent assay (ELISA) kit (HITAZYME C. pneumoniae kit) indicated that 13 children (20.3%) were infected with C. pneumoniae. Our results indicate a high prevalence rate of C. pneumoniae, suggesting it is as an important causative pathogen of childhood pneumonia in Bangladesh.     

Intracranial tumors in the first year of life

Among 100 childhood brain tumors treated at Kobe Children's Hospital from May 1970 to June 1985, 18 of the children presented with symptoms during the first year of life. This paper analyzes these 18 cases. Supratentorial tumors (78%) were more common than infratentorial ones, and 67% of all the tumors were located in the central neural axis. Initial symptoms were cranial enlargement (56%), vomiting (17%), cranial deformity (11%), blepharoptosis, respiratory distress, and ataxia. Histological diagnosis of the tumors was as follows: teratoma (3 cases), medulloblastoma (3), glioblastoma (2), astrocytoma (2), ependymoma (2), craniopharyngioma (1), choroid plexus papilloma (1), hamartoma (1), lipoma (1), melanotic progonoma (1), and an undetermined type, probably medulloblastoma (1). Seventeen of the patients underwent craniotomy for tumor resection (4 total, 4 subtotal and 7 partial removal, and 2 biopsies). Additional therapeutic methods used separately and in various combinations included ventriculoperitoneal shunt, subduralperitoneal shunt, ventricular drainage, radiotherapy and chemotherapy. Nine patients died (average 98 days) after surgery. Of the 9 survivors, 6 are still alive after more than 5 years. Five of the 6 are mentally retarded and 4 are physically handicapped to some degree.Presented at the 13th Annual Meeting of the International Society for Pediatric Neurosurgery     

Estradiol sensitivity test using contact-sensitive plates of confluent BALB/c 3T3 cell monolayers

We have attempted to develop an in vitro assay system for predicting estradiol sensitivity of clinical cancer cells by measuring the effects of estradiol on the net DNA synthesis of primary culture cells. Superinoculation of neoplastic and normal cells onto confluent monolayers of a contact-sensitive cell line, which have been designated as contact-sensitive plates (CSPs), resulted in both the specific growth of the neoplastic cells and the growth inhibition of contact-sensitive normal cells. The applicability of CSPs to an estradiol sensitivity test was examined in the known estradiol-sensitive, estrogen receptor-possessing cell lines, MCF-7 breast cancer and KSE-1 esophageal cancer cells. The responses of each cancer cell to estradiol were sufficiently evaluated in this assay and clearly demonstrated stimulative and inhibitive growth regulatory effects of the estradiol in MCF-7 and KSE-1 cells, respectively. A total of 38 clinical carcinomas (33 of the breast and 5 of the esophagus) were tested for their estradiol sensitivity. A statistically significant increase of cancer cell growth (P less than 0.1) in nontreated culture from the 48th to the 96th h of the primary culture on CSPs was observed in 28 of 38 overall cases (73.7%), and the evaluable data were obtained within 5 days by a sampling of 5 X 10(3) cancer cells. Most of the breast carcinomas exhibited a positive correlation between the growth-stimulative effect of estradiol in this assay and the estrogen receptor levels in the resected specimens. On the other hand, a clinical case of esophageal cancer with an estrogen receptor showed a growth inhibition of primary carcinoma cells by estradiol treatment. These results therefore indicate the feasibility of predicting individual tumor response to estradiol by using a rapid sensitivity test in vitro.     

Acute portal hypertension associated with liver resection. Analysis of early postoperative death

Changes in portal pressure before and after hepatic resection were monitored in 65 patients. Significant increases in portal pressure, from 226 +/- 13 mm saline to 277 +/- 16 mm saline were noted in 17 cirrhotics undergoing major hepatic resection. In 14 noncirrhotics undergoing major resection of the liver, pressure in the portal vein changed significantly from 198 +/- 10 mm saline to 226 +/- 9 mm saline. Conversely, there were no differences in the 26 cirrhotic and eight noncirrhotic individuals who underwent minor hepatic resection. Clinical analysis of these patients showed that acute portal hypertension induced by liver resection was not linked to increases in early postoperative death.     

Prognostic study of intramucosal carcinoma of the stomach with DNA aneuploidy

Cell nuclear DNA content was microspectophotometrically measured in 70 patients with a gastric carcinoma lesion of less than 4.0 cm in diameter and with mucosal or minimal submucosal invasion. Two groups were prepared; low ploidy and high ploidy, according to the degree of dispersion on the DNA histogram. Twenty-four cases of high ploidy were reviewed from the aspects of clinicopathology and prognosis and the findings compared with data on 46 of low ploidy. The high ploidy group was characterized by an elevated lesion and a differentiated carcinoma while the low ploidy group had a depressed lesion and an undifferentiated carcinoma Postoperative recurrence was confirmed in none of the low ploidy cases and 2/24 of the high ploidy cases. The five and ten-year survival rates of the patients with high ploidy were 100 per cent and 91.1 per cent, respectively. Compared to the findings that patients with submucosal carcinoma of high ploidy survived at a rate of only 64.8 per cent in the 5-year follow-up, efforts should be directed toward a higher detection of gastric carcinoma with aneuploidy at the stage limited to within the intramucosal layer. Endoscopic treatment for early gastric carcinoma is not recommended, especially for a differentiated carcinoma, even if the invasion is confined to the mucosa, since it may include aneuploid carcinoma.