Repeated epicardial coronary artery endothelial injuries lead to a global spontaneous coronary artery spasm

OBJECTIVES: This study was conducted to develop a spontaneous coronary spasm model. MATERIALS AND METHODS: Balloon endothelial denudation was carried out in the epicardial left anterior descending coronary artery (LAD) every 2 weeks, for a total of four times, in 12 pigs. Changes in the denuded site diameter and LAD blood flow caused by acetylcholine or serotonin were assessed before each denudation and at week 8. Blood pressure, electrocardiogram (ECG) from the LAD area and LAD blood flow were monitored continuously in conscious and unrestrained pigs. RESULTS: Spontaneous ECG ST depression with a decrease in LAD blood flow appeared at around 2 weeks. In accordance with this, 0.5 microg/kg acetylcholine induced similar ECG and LAD blood flow changes without denuded site narrowing, suggesting microvascular spasm. Thereafter, ECG ST depression or elevation by serotonin via a denuded site spasm was found after 6 weeks and spontaneous ECG ST changes due to epicardial coronary artery spasm were observed. CONCLUSION: Epicardial coronary artery endothelial injury may induce spontaneous vasospasticity in the downstream coronary microvessels as well as in the denuded portion, suggesting functional abnormality through the entire coronary arterial tree.     

Quantitative determination of sugars and myo-inositol in citrus fruits grown in Japan using high-performance anion-exchange chromatography

Fifteen commercial samples of citrus fruits grown in Japan were analyzed for their sugar contents by high-performance anion-exchange chromatography (HPAEC) and electrochemical detection (ED) coupled with a stationary phase D10 column prepared using chloromethylated styrene-divinylbenzene copolymer and N,N,N',N'-tetramethyldiaminodecane. Myo-inositol, glucose, fructose, and sucrose in all of these various citrus fruits could be successfully separated within 25 min using 0.5 M NaOH eluent at a flow-rate of 0.4 mL/min. Myo-inositol, as a better nutritional source, was found in all the citrus fruits grown in Japan (0.7 +/- 0.04-2.1 +/- 0.2 g/L). The sugar contents of twelve citrus fruits grown in other countries were also determined.     

Endobronchial carcinoid tumor combined with pulmonary non-tuberculous mycobacterial infection: report of two cases

We report here two cases of endobronchial carcinoid tumor complicated with pulmonary infection with non-tuberculous mycobacteria (NTM). Case 1 was an 81-year-old woman with the left lower lobe atelectasis. Bronchoscopy showed complete obstruction of the left basal bronchus by a tumor and a sleeve lower lobectomy with mediastinal lymph node dissection was performed. Pathological examination showed typical carcinoid located in the left basal bronchus and many caseous granulomas containing mycobacteria in the lung parenchyma distal to the bronchus. Bacterial examinations of sputum and gastric juice after the operation showed a growth of Mycobacterium kansasii. Case 2 was a 50-year-old woman with the atelectasis of the left upper division. Bronchoscopy showed complete obstruction of the left upper division bronchus by a tumor and a left upper lobectomy with mediastinal lymph node dissection was performed. Pathological examination showed typical carcinoid located in the left upper division bronchus and many caseous granulomas in the lung parenchyma distal to the bronchus. The Ziehl-Neelsen stain showed many mycobacteria in these granulomas and they were identified as Mycobacterium avium by PCR analysis. Although NTM are not well recognized as possible pathogens of pulmonary infection related to bronchial obstruction by endobronchial carcinoma, our experiences rouse a caution to consider NTM as potential pathogens. We also discuss the possible mechanisms responsible for the specific relationship between carcinoid tumor and TNM.     

A new irradiation unit constructed of self-moving gantry-CT and linac

PURPOSE: To improve reproducibility in stereotactic irradiation (STI) without using noninvasive immobilization devices or body frames, we have developed an integrated computed tomography (CT)-linac irradiation system connecting CT scanner and linac via a common treatment couch. METHODS AND MATERIALS: This system consists of a linac, a CT scanner, and a common treatment couch. The linac and the CT gantry are positioned on opposite ends of the couch so that, by rotating the treatment couch, linac radiotherapy or CT scanning can be performed. The rotational axis of the linac gantry is coaxial with that of the CT gantry, and the position of the linac isocenter on the couch matches the origin of the coordinate system for CT scanning when the couch is rotated 180 degrees toward the CT side. Instead of the couch moving into the gantry, as in conventional CT, in this case the table is fixed and scanning is accomplished by moving the gantry. We evaluated the rotational accuracy of the common couch and the scan-position accuracy of the self-moving gantry CT. RESULTS: The positional accuracy of the common couch was 0.20, 0.18, and 0.39 mm in the lateral, longitudinal, and vertical directions, respectively. The scan-position accuracy of the CT gantry was less than 0.4 mm in the lateral, longitudinal, and vertical directions. CONCLUSION: This irradiation system has a high accuracy and is useful for noninvasive STI and for verification of the position of a target in three-dimensional conformal radiotherapy.     

Effect of moxibustion stimulation of various skin areas on cortical cerebral blood flow in anesthetized rats

The effect of moxibustion stimulation of various skin areas (cheek, forepaw, upper arm, chest, back, lower leg, hindpaw and perineum) on cerebral blood flow (CBF) of the parietal cortex was examined in anesthetized rats after eliminating emotional influences. Moxibustion stimulation was performed by burning a moxa cone of about 4 mg weight placed on the shaved skin. CBF of the parietal cortex was measured using a laser Doppler flowmeter. Stimulation of the cheek, forepaw, upper arm and hindpaw produced significant increases in CBF, but stimulation of the other areas did not produce significant responses. Moxibustion stimulation of the forepaw and hindpaw produced an increase in the mean arterial pressure (MAP), while stimulation of the other areas did not. After spinal transection at the 2nd thoracic level, the MAP response to stimulation of the forepaw was abolished, whereas the CBF response to stimulation of the forepaw remained. The CBF response in spinalized rats was not affected by cutting cervical sympathetic and facial parasympathetic nerves, while it was almost abolished by intravenous administration of muscarinic and nicotinic cholinergic blocking agents. The CBF response was abolished by crushing the brachial plexus ipsilateral to the stimulated side. It is suggested that the increase in CBF, independent of MAP and emotional responses, elicited by moxibustion stimulation is a reflex response whose afferent pathway is composed of somatic afferent nerves, and whose efferent pathway involves intracerebral cholinergic nerves. A contribution of endogenous opioids in the present CBF responses was neglected, because naloxone did not influence the CBF responses.     

ABO incompatible kidney transplantation --immunological aspect-

ABO incompatible kidney transplantation (ABOINCKT) has been developed in Japan because of the shortage of cadaveric donors. We have performed 76 living-donor ABOINCKT in our center. Donor blood type antibody was removed by immunoadsorption or plasmapheresis and exchange. Immunosuppression consisted of cyclosporine or tacrolimus, steroid, and cyclophosphamide or azathioprine or mycophenolate mofetil and, recently, basiliximab. Splenectomy was routinely performed during the transplantation surgery. Donor blood type antigen was strongly expressed on the vascular endothelium at all time points and in all conditions posttransplantation. Red blood cell agglutination reaction (RBAR) was positive only in renal tissues from a patient with delayed hyperacute rejection. Donor specific antibody suppression was observed in 18 ABOINCKT recipients with blood type O from a donor with blood type A1 or B. ADCC activity was detected after pre-treatment. Acute humoral rejection in ABOINCKT can result from ADCC, as well as by antigen-antibody reaction. Five year graft and patient survival rates were 75% and 64% in 37 ABOINCKT recipients from June 1989 through December 1996, however they have been 100% in 39 ABOINCKT recipients since January 1997. Accommodation has been produced in ABOINCKT with the co-existence of blood type antigen and antibody. Currently, ABOINCKT is an alternative which should be considered, particularly for blood type O patients with extended waits for cadaveric transplantation and for pediatric patients.     

Results of surgical treatment for primary lung cancer; time trends of survival and clinicopathologic features

To assess whether the survival of patients who underwent surgical resections for non-small cell lung cancer (NSCLC) improved, we examined the time trends for survival after operation. A total of 851 consecutive patients with NSCLC who underwent surgical resections between 1979 and 2000 were retrospectively reviewed by 3 groups according to year of the operation: the early period (from 1979 to 1986, n = 138), the middle period (from 1987 to 1993, n = 288), and the late period (from 1994 to 2000, n = 425). There were 606 men and 245 women with a mean age of 65.4 years. The histologic type included 453 adenocarcinoma, 282 squamous cell carcinoma, and 63 large cell carcinoma. The pathologic stage included 203 stage I A, 171 stage I B, 21 stage II A, 117 stage II B, 180 stage III A, 123 stage III B, and 36 stage IV diseases. The mean age at the middle and late periods showed a significant increase compared with the early period. There were no significant histologic differences among the three periods. The ratio of patients with stage I A disease increased significantly at the middle and late periods compared with the early period. The 5-year survival rate of the 851 patients was 43.7%, and the median survival was 44.8 months. The 5-year survival rates at the early, the middle, and the late periods were 33.3%, 44.2%, and 45.8%, respectively, with significant improvement at the middle and late periods compared with the early period. The overall 30-day operative mortality was 2.2% (19/851): 8.7% (12/138) at the early period, 1.4% (4/288) at the middle period, and 0.7% (3/425) at the late period, showing significant decrease during the middle and late periods compared with the early period. The postoperative prognosis of patients with resected NSCLC during the later periods had a better survival, which was caused by an increase in the ratio of patients with stage I A disease, and a decrease in the rates of operative mortality.