Platypnea-orthodeoxia syndrome combined with multiple congenital heart anomalies

A 71-year-old woman was admitted for paralysis on the left side of her body. She developed dyspnea and hypoxemia after admission. Although pulmonary embolism was suspected, hypoxemia and dyspnea occurred repeatedly in spite of anticoagulation therapy. Transesophageal echocardiography revealed a patent foramen ovale (PFO), an atrial septal aneurysm (ASA), and a right-to-left shunt that appeared in an upright position. She was diagnosed with platypnea-orthodeoxia syndrome. Moreover, cardiac catheterization showed congenital anomalies, such as unroofed coronary sinus, partial anomalous pulmonary venous return and persistent left superior vena cava. Simple surgical closure of the ASA and PFO improved all of her symptoms.     

Acute infantile gastroenteritis caused by rotavirus in Japan

We had an outbreak of acute infantile gastroenteritis accompanied by milky-white stool (called Hakuri in Japanese) during the winters of 1976 and 1977. Stool specimens collected from 72 cases of Hakuri were studied by negative-staining electron microscopy. Rotavirus was detected with a very high frequency (89%).Rotavirus obtained from one of the patients was isolated and passaged in cultures of primary human embryonic kidney cells. Viral antigens could be detected in the cytoplasm of the cells by indirect immuno-fluorescence. The fluorescence-positive cells increased in number with repeated passage.Serum anti-viral activities in 11 patients were titrated by indirect immuno-fluorescence, using the cells infected with the passaged rotavirus. All 11 patients developed IgM responses in the convalescent phase. However, in 4 of the 11 patients, no IgG responses were detected even 2–3 weeks after the onset of illness. The reinfection which has occasionally be seen in our country may be related to these poor IgG responses.     

Expression profiles of zinc transporters in rodent placental models

Zinc is a vital metal that is a structural and functional component of many proteins. The precise mechanism of zinc transport in the placenta remains unclear. In this study, we investigated the expression of zinc transporters (ZnTs) in the mouse placenta and in two rat trophoblast cell lines, TR-TBT cells, which are syncytiotrophoblast cells of the labyrinth zone, and Rcho-1 cells, which retain trophoblast cell features and differentiate into trophoblast giant cells of the junctional zone. All of the ZnTs that have been identified in mice (ZnT1-7) were detected in the mouse placenta by RT-PCR. The expression profiles of ZnTs in the placenta during pregnancy were different. The mRNA levels of ZnTs, with the exception of ZnT7, did not change during pregnancy. The ZnT7 mRNA level in placenta was elevated during pregnancy. In TR-TBT cells, ZnT1, ZnT3 and ZnT4 were detected by RT-PCR analysis. In Rcho-1 cells, all of the ZnTs that have been identified in rats (ZnT1-4) were detected by RT-PCR analysis. There were no differences between the mRNA expression levels of ZnT family members in undifferentiated Rcho-1 cells and differentiated Rcho-1 cells. This is the first report of expression profiles of ZnTs during differentiation of the placenta in the mouse placenta and rat placental cell models.     

Effects of L-arginine infusion during ischemia on gut blood perfusion, oxygen tension, and circulating myeloid cell activation in a murine gut ischemia/reperfusion model

BACKGROUND: Gut hypoperfusion is considered to be a mechanism for early multiple‐organ failure after severe surgical insults. L‐Arginine (ARG) may preserve gut microcirculation as a substrate of nitric oxide synthase, but simultaneously may enhance immune cell response. It remains unknown if ARG infusion during gut ischemia improves the outcome after gut ischemia‐reperfusion (I/R). METHODS: Male Institute of Cancer Research mice were randomized to control and ARG groups. After i.v. cannulation, mice underwent 90 (Exp. 1) or 60 (Exp. 2 and 3) minutes of gut I/R. Control mice received normal saline infusion at 1 mL/h for 60 minutes during ischemia, whereas the ARG group was given 1% ARG hydrochloride solution. In Exp. 1, survival was observed for 72 hours (n = 35). In Exp. 2, blood perfusion and oxygen tension of the small intestine were measured (n = 9). In Exp. 3, peripheral blood was obtained at 2 or 4 hours after reperfusion (n = 22). Reactive oxygen intermediate (ROI) production by myeloid cells with or without phorbol myristate acetate (PMA) stimulation and expression of CD11a and CD11b on myeloid cells were examined using flow cytometry. RESULTS: Exp. 1: There was no significant difference in survival times (log rank test, p =.2). However, survival rates at 12 hours were 72% (13/18) for the control group and 35% (6/17) for the ARG group (p <.05 Fisher). Exp. 2: ARG infusion significantly improved gut blood perfusion ratio during ischemia but had no effect on oxygen tension. Exp. 3: In the ARG group, ROI production with PMA and CD11b expression at 4 hours were higher than those at 2 hours, whereas there were no significant changes in the control mice. CONCLUSIONS: ARG infusion improves intestinal blood perfusion during ischemia but primes and activates circulating myeloid cells excessively. Consequently, i.v. infusion of ARG during ischemia reduces survival rate.     

L-arginine-enriched parenteral nutrition affects lymphocyte phenotypes of gut-associated lymphoid tissue

BACKGROUND: Experimentally, total parenteral nutrition (TPN) diminishes gut-associated lymphoid tissue (GALT) cell numbers and function. Although glutamine supplementation is known to reverse TPN-induced changes in GALT, effects of another conditionally essential amino acid, L-arginine (ARG), on GALT remain unclear. METHODS: Twenty-two male Institute of Cancer Research mice were randomized to standard TPN (0.3% arginine, STD-total parenteral nutrition) or 1% ARG-enriched TPN (ARG-total parenteral nutrition). After 5 days of feeding, lymphocytes were harvested from Peyer's patches (PP), the lamina propria, and intraepithelial (IE) spaces of the small intestine to determine cell yields. Lymphocyte phenotypes (alphabetaTCR, gammadeltaTCR, CD4, CD8, and B220 as a B cell marker) were determined using flow cytometry. IgA levels in washings of the small intestine, upper respiratory tract, and lungs were measured with ELISA. RESULTS: ARG-total parenteral nutrition did not affect lymphocyte yields. The percentages of CD4+ cells in PP and IE, and alphabetaTCR+ cells in PP, were significantly higher in the ARG-total parenteral nutrition than in the STD-total parenteral nutrition mice, without marked differences in other phenotypes examined. There were no significant differences in intestinal and respiratory tract IgA levels between the 2 groups of mice. CONCLUSIONS: One percent ARG supplementation of TPN does not improve GALT cell number or mucosal IgA level but benefits to increase CD4+ cell percentages in GALT.     

Evaluation of creatine kinase level during long-term tocolysis

OBJECTIVE: This study was performed to evaluate serum creatine kinase (CK) levels during tocolytic therapy. METHODS: A retrospective study was performed in 27 patients who were treated with intravenous tocolytic agents for more than one week. The first-line tocolytic agent was ritodrine hydrochloride, followed by concomitant magnesium sulfate (MgSO4). The serum CK level was measured on admission and every week thereafter. The patients were divided into the normal CK (group 1) and abnormal CK (> 150 IU/L) (group 2) groups. RESULTS: Seventeen patients received both ritodrine hydrochloride and MgSO4. The CK levels in all patients rose significantly from 58.4 +/- 30.8 IU/L on admission to 116.0 +/- 68.7 IU/L on day 7 (p = 0.002). Abnormal elevation of CK occurred in 7 (25.9%) of the 27 patients. Significant differences were found between groups 1 and 2 in the total doses of ritodrine and MgSO4 (p = 0.046 and p = 0.0028, respectively). All patients in group 2 received ritodrine in combination with MgSO4 (p = 0.018). CONCLUSION: When tocolytic therapy continued for more than 1 week, nearly one-fourth of patients showed an increase in CK level above the normal range.     

A case of paraganglioma of the urinary bladder]

A 50-year-old male was referred to our department because of dysuria. On cystoscopy, a submucosal bladder tumor was seen at the posterior wall of the urinary bladder. Transurethral resection was performed with no intraoperative complications. Histopathological diagnosis of paraganglioma was confirmed by immunohistochemical staining.     

Radiologic manifestations of peritoneal mesothelioma

We report four cases of histologically proved peritoneal mesothelioma and describe the radiographic (mainly CT and angiographic) findings. There were three malignant diffuse tumors and one benign localized tumor. In one case, the lesion extended to the omentum and entrapped the fat tissue, and differentiation from peritonitis carcinomatosa was difficult. In the other three cases, reflecting necrotic change within the tumor, CT showed hypodensity throughout most of the mass. In two cases with hemorrhage, CT showed hyperdensity in the center of the mass. Angiography showed slight or medium neovascularity in the periphery of the tumor, but most of the tumor was avascular. Angiography was helpful for topographic diagnosis, but it was difficult to make a specific diagnosis or differentiate between malignant and benign types. We emphasize that it is important to consider peritoneal mesothelioma in the differential diagnosis when a mass of unknown origin is found in the abdomen, particularly when it is accompanied by necrosis and hemorrhage.