Repair of an acute type a dissection: Fate of the remnant false lumen and preserved aortic valve

(Received for publication on Nov. 10, 1997; accepted on Sept. 11, 1998)     

In vivo scavenging effect of ethylcysteine on reactive oxygen species in human semen]

PURPOSE: The production of reactive oxygen species (ROS) is a normal physiological event in various organs including the testis. Overproduction of ROS, however, can be detrimental to sperm, being associated with male infertility. In vivo experiments using vitamin E (Vit. E), one of the major membrane protectants against ROS and lipid peroxidation, have shown its significant potential in treating ROS-associated male infertility. There has been no study that the scavenging drugs reduce the level of ROS in human semen. Previously we reported the in vitro scavenging effectiveness of ethylcysteine (EC) against ROS in human semen. The present study was performed in order to determine the effectiveness of the in vivo administration of EC as treatment for ROS-associated male infertility. PATIENTS AND METHODS: Ten cases of male infertility, with the exceptions of azoospermia and pyospermia, were chosen. Patients were divided randomly into two groups. Each group received either 600 mg/day of EC (Group A) or Vit. E 600 mg/day (Group B) for 3 months. Then, after a 1-month wash-out period, the patients were switched to another treatment. Conventional semen analysis, computerized motility assessment, measurement of ROS generation and sperm function assessment by triple stain were performed before and after administration of EC and Vit. E. The levels of EC and Vit. E were also assessed in patients' blood serum and seminal plasma before and after administration of EC and Vit. E. RESULTS: Sperm density and sperm motility did not improve but sperm function had a significant tendency toward improvement after administration of EC and Vit. E. ROS levels significantly decreased only after administration of EC After administration of EC and Vit. E, their levels significantly increased in patients' blood serum but were unchanged in patients' seminal plasma. CONCLUSION: Since our study showed that oral administration of EC produced results similar to those of Vit. E, we conclude that EC is an effective treatment agent for ROS-associated male infertility.     

A case of mitral valve replacement combined with idiopathic thrombocytopenic purpura (ITP)]

We conducted mitral valve replacement (MVR) in a patient with mitral regurgitation (MR) complicated with idiopathic thrombocytopenic purpura (ITP). The patient was a 62-year-old male who was diagnosed to have grade IV MR. However, a decrease in platelet count was noted (5.6 x 10(4)/microliter) when he has admitted to this hospital for operation. After detailed examination, he was diagnosed to have ITP. Though mass intravenous infusion of gamma-globulin (400 mg/kg/day, for 5 days) was done before the operation, the treatment was not successful and splenectomy was consequently conducted. In view of the influence of invasive splenectomy, the change in platelet count was carefully observed thereafter. The count subsequently increased to reach a peak (26.9 x 10(4)/microliter) after 2 weeks from the splenectomy. MVR was conducted when the count started to decrease again after the peak. The operation was safely completed without any complication such as hemorrhage during and after the operation. Since gamma-globulin treatment and splenectomy are sometimes ineffective in ITP, it is advisable to wait an operation until the effects of these treatments are clarified.     

Isolation of epileptiform discharges from unaveraged EEG by independent component analysis.

OBJECTIVE: We propose a method that allows the separation of epileptiform discharges (EDs) from the EEG background, including the ED's waveform and spatial distribution. The method even allows to separate a spike in two components occurring at approximately the same time but having different waveforms and spatial distributions. METHODS: The separation employs independent component analysis (ICA) and is not based on any assumption regarding generator model. A simulation study was performed by generating ten EEG data matrices by computer: each matrix included real background activity from a normal subject to which was added an array of simulated unaveraged EDs. Each discharge was a summation of two transients having slightly different potential field distributions and small jitters in time and amplitude. Real EEG data were also obtained from three epileptic patients. RESULTS: Through ICA, we could isolate the two epileptiform transients in every simulation matrix, and the retrieved transients were almost identical as the originals, especially in their spatial distributions. Two epileptic components were isolated by ICA in all patients. Each estimated epileptic component had a consistent time course. CONCLUSION: ICA appears promising for the separation of unaveraged spikes from the EEG background and their decomposition in independent spatio-temporal components.     

Evaluation of MAST-26, newly developed system for the detection of IgE antibodies]

MAST-26 is a new allergy testing system which allows simultaneous determination of allergen-specific IgE antibody levels for 26 allergens using 200 microliters of patient serum. To evaluate the effectiveness of MAST-26 for the detection of allergen-specific IgE antibody, a total of 100 serum samples were collected from allergic patients at five facilities, and allergen-specific IgE antibody was measured by MAST-26. 14% of them were positive to > or = 10 allergens. If the patients had severe allergic symptoms, they were likely to show positive to many allergens. A good correlation was found between the results obtained by MAST-26 with those measured by CAP RAST and by intradermal skin test. It was concluded that MAST-26 is an effective screening method for the detection of allergen-specific IgE.     

Closure of calcified patent ductus arteriosus.

Patent ductus arteriosus (PDA) in adults is occasionally associated with calcification and pulmonary hypertension, for which an anterior approach through a median sternotomy with cardiopulmonary bypass is often used. Sutures are placed without circulatory arrest by using a transpulmonary balloon catheter as an occluder. To secure the suture tie, we used Nélaton's catheters as tourniquets.     

Myeloperoxidase-antineutrophil cytoplasmic antibody positive alveolar hemorrhage during propylthiouracil therapy for hyperthyroidism]

A 62-year-old woman had been treated with propylthiouracil(PTU) for hyperthyroidism. Because bloody sputum, dyspnea, and severe hypoxemia developed, the patient was admitted to our hospital. Chest X-ray and chest computed tomographic (CT) films disclosed diffuse infiltrative shadows in both lung fields. Bronchoalveolar lavage revealed abundant hemosiderin-laden macrophages. Alveolar hemorrhage associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) positive vasculitis syndrome was diagnosed because of the high serum level of MPO-ANCA. After the initiation of steroid therapy and termination of PTU, the infiltrative shadows in both lung fields disappeared, PaO2 improved, and MPO-ANCA decreased. There have been some reports of MPO-ANCA positive vasculitis syndrome developing during PTU therapy, but most were concerned with renal disease. We concluded that PTU and similar agents should be given consideration as one of the possible causes of MPO-ANCA-induced alveolar hemorrhage.     

Neutrophil Activation in Immunoadsorption

Abstract: Immunoadsorption therapy (IAT) is used in the treatment of autoimmune diseases. Although IAT has been reported to modify humoral immunity by inducing chemokines and activating complements, much remains unknown about the biological effects of IAT on cellular components in peripheral blood. To define the influence of IAT on leukocytes, we determined leukocyte l ‐selectin (CD62L) and Mac‐1 (CD11b) as parameters for activation of leukocytes in peripheral blood during IAT. Peripheral leukocyte l ‐selectin and Mac‐1 were determined continuously by flow cytometry in 6 patients with neuroimmunological disorders in whom IAT was conducted using a Plasma Flow OP‐05 (Asahi Medical Corp., Tokyo, Japan) as a plasma separator and Immusorba TR‐350 (Asahi Medical Corp., Tokyo, Japan) as an adsorption column. Expression of neutrophils (PMN) l ‐selectin was decreased 30 min after starting IAT, with the decreases particularly marked at the end of IAT, while expression of mononuclear cells (MNC) l ‐selectin slightly increased during IAT. Expression of PMN Mac‐1 was markedly increased at the end of IAT, whereas expression of MNC Mac‐1 did not change during IAT. Leukocyte counts decreased 30 min after starting IAT, and then increased to the initial level or higher in parallel with l ‐selectin downregulation and Mac‐1 upregulation on PMN. l ‐selectin downregulation and Mac‐1 upregulation on PMN suggested that activation of PMN associated with changes in peripheral leukocyte counts occurred during IAT and might play some role in modulating the human circulating blood and immune systems.     

Urothelial cytoprotective activity of Tamm–Horsfall protein isolated from the urine of healthy subjects and patients with interstitial cystitis

PURPOSE: Tamm-Horsfall protein (THP) is a ubiquitous urinary protein with essentially no known function. We propose that THP is a cytoprotective agent that protects the urothelium from cationic species. To test this hypothesis we isolated THP from normal and interstitial cystitis urine to see if it could protect cultured cells from damage induced by the polyamine, protamine sulfate (PS). METHODS: Tamm-Horsfall protein was extracted from the urine of interstitial cystitis (IC) patients (N=28) and normal volunteers (N=5). Urothelial target cells (T24) were radiolabeled with 51Cr and then exposed to PS (0-1.0 mg/mL) for either 1.5 or 20 h. The resulting cytotoxicity data (dose-response curves) were then compared with the data obtained when PS was preincubated with 0-0.5 mg/mL of THP (IC vs normal), the semisynthetic polysaccharide, pentosan polysulfate (Elmiron), or human serum albumin. RESULTS: Toxicity of PS was significantly reduced by incubation with THP (or Elmiron) prior to evaluation by the chromium release assay, but not reduced by incubating with another protein, albumin. Tamm-Horsfall protein from IC patients' urine was less protective than an equal quantity of THP from normal urine. CONCLUSIONS: These experiments suggest that THP has an important role in bladder mucosal defense mechanisms, protecting the bladder surface from injury. Inability of THP to prevent cytotoxic damage by urinary polyamine or other urinary toxins (cationic species) may be relevant in the etiology of interstitial cystitis, as putative urinary toxic components have been described in the urine of some patients.     

Assessment of the efficacy and safety of a Judo exercise program in improving the quality of life among elderly patients

Objectives: Several reports have shown that Tai Chi Chuan can be an effective way to prevent falls among the elderly. However, an exercise program that can prevent injury during falls has not been reported previously. The judo technique called ukemi is used to prevent injuries. To evaluate whether a judo-based exercise program could prevent falls in the elderly, we had the participants practice ukemi as part of a therapeutic routine. The purpose of this study was to examine the clinical significance of the program and to predict its safety.Methods: From July 2016 to March 2017, we examined 53 individuals who participated in the exercise program. The individuals were divided into high (n=39) and low (n=14) movement ability groups (HMA and LMA groups, respectively), and their physical and psychological functions were evaluated using scores from the Short-Form Health Survey 36. We also collected and analyzed data from questionnaires obtained from 384 patients who participated in the program from July 2016 to July 2019.Results: The HMA group showed a significant increase in the mental component summary scores before and after the exercise program. In the LMA group, physical functioning, social functioning, and physical component summary scores were significantly improved. Of the participants surveyed, 94.8% had a high level of satisfaction, and 93.2% began accepting the exercise as a daily habit. No adverse events were observed during these exercises.Conclusion: This novel exercise program was performed safely, and positive effects were observed, especially in individuals with a low quality of life.