gamma-Aminobutyric acid enhances the tone of human internal anal sphincter.

The effect of gamma-aminobutyric acid (GABA) on the human internal anal sphincter was investigated. Cumulative applications of GABA produced concentration-dependent contractions (10(-8)-10(-5) M) of the isolated human sphincter. Pretreatment with bicuculline (GABAA antagonist) turned them to relaxation. Muscimol, a GABAA agonist, induced concentration-dependent contractions (10(-8)-10(-5) M); however, baclofen (GABAB agonist, 10(-8)-10(-5) M) promoted concentration-dependent relaxation of the strips. These results suggested that both excitatory GABAA receptors and inhibitory GABAB receptors exist in the internal anal sphincter. Oral administration of sodium valproate (1600 mg/day), a GABA transaminase inhibitor, enhanced the anal canal resting pressure in 10 normal volunteers. Anal manometry showed a significant elevation in tonus without affecting amplitudes or frequencies. These results indicated that endogenous GABA, which was increased by sodium valproate, produced elevations in the anal canal resting pressure through its specific receptors in the human internal anal sphincter.     

A patient with severe ventricular tachycardia who was saved by prolonged extracorporeal lung and heart assist]

A 47-y-o man had been suffering from cardiac failure due to refractory ventricular tachycardia (VT) after myocardial infarction. He underwent resection of the left ventricular aneurysm and cryocoagulation of the arrhythmogenic foci. On the 2nd post-operative day, VT often recurred in spite of repeated cardioversion and drug therapy, and threatened his life, even under IABP. Therefore, a veno-arterial bypass route was made and extracorporeal lung and heart assist, ECLHA, was started with a heparin bonded Maxima lung on the following day. Even under ECLHA, VT continued to recur. Cryocoagulation of the VT foci was tried again, without immediate success. A record high dose of beta-blockers, given under the circulatory support by ECLHA, stopped VT on the following day. The patient was weaned from the ECLHA circuit 12 days after the first operation, then from IABP on the 14th day. During the 10 day course of surgeries and ECLHA, the patient had almost 100 defibrillations. But for ECLHA, we may say that the patient couldn't have survived two open heart surgeries, administration of a great amount of beta-blockers, and repeated cardiac arrest without neurological sequelae.     

Changes in the volume and histology of retractile testes in prepubertal boys

Testicular development was studied in prepubertal boys with retractile testes. Testicular volume, the diameter of the seminiferous tubules and the number of spermatogonia in the tubules were decreased in cases of unilateral retractile testis, when compared with values for the contralateral normally descended testis. On the other hand, in patients with a unilateral retractile testis and contralateral inguinal testis, there was no difference in the developmental parameters between the two testes. These results suggest that the retractile testis has developmental failures characteristic of a cryptorchid testis and therefore requires orchiopexy.     

A case of emergency surgery for acute mitral regurgitation due to complete papillary muscle rupture as complication of acute inferior myocardial infarction

We experienced a case with acute mitral regurgitation caused by complete posterior papillary muscle rupture as complication of acute inferior myocardial infarction, who underwent successfully emergency operation of mital valve replacement and coronary revascularization in acute stage. A 64-year-old woman developed sudden cardiogenic shock shortly after the onset of acute inferior myocardial infarction. The diagnosis of acute inferior myocardial infarction was based on the electrocardiographic findings. Under IABP support, preoperative coronary angiography visualized total occlusion of segment 3 of the right coronary artery, and preoperative left ventriculography showed akinesis of inferior wall and severe mitral regurgitation. At 6 hours after onset of papillary muscle rupture, emergency operation was performed. At operation, posterior papillary muscle was found to be totally ruptured. Coronary artery revascularization and mitral valve replacement were performed. Postoperative course was uneventful, with 4 days of IABP and 5 days of ventilatory support. She was discharged on the twentieth postoperative day in NYHA class I. Reports of successful emergency operation for total papillary muscle rupture following acute myocardial infarction are rare. Early diagnosis and surgical treatment are mandatory to save this group of patients.     

"Dynamic" MR imaging of the cervical cord in patients with cervical spondylosis and ossification of the posterior longitudinal ligament--significance of dynamic cord compression]

This investigation was designed to assess the influence of dynamic cord compression on severity and course of myelopathy. Sixty-seven patients studied comprised 54 cases of cervical spondylosis and 13 cases of ossification of the posterior longitudinal ligament. These patients underwent "dynamic" MR imaging of the cervical spine. MR images in the sagittal view were obtained in three different neck positions: flexion, neutral, and extension. MR imaging was performed with a 0.15 T resistive unit. For technical reasons, the body coil was used. The pulse sequence was 500/30 (Tr msec/echo time msec) for T1 images. The spinal cord compression was accelerated in 32 cases when extended, in 2 cases when flexed, and in 4 cases when both extended and flexed. In 21 cases, we compared myelograms with MR images in a same neck position. Findings of myelograms well corresponded with those of MR images on 83 percent of intervertebral levels. The patients with dynamic cord compression were proved to have severer long tract signs, and their disability was regressive or progressive case by case for an average of 21-month follow-up. The "dynamic" MR imaging can provide dynamic nature of spinal cord compression, and prognostic clues.     

Use of enzyme-linked immunosorbent assays with chimeric fusion proteins to titrate antibodies against Epstein-Barr virus nuclear antigen 1.

Two new enzyme-linked immunosorbent assays (ELISAs) with chimeric fusion polypeptides for the detection of human antibodies specific to Epstein-Barr virus nuclear antigen 1 (EBNA-1) are described. One is an indirect ELISA with affinity-purified beta-galactosidase-EBNA-1 fusion protein as the antigen. The other is a "sandwich" assay based on the use of anti-beta-galactosidase antibody to capture beta-galactosidase-EBNA-1 fusion proteins in bacterial extracts. A good correlation was shown between antibody titers determined by the ELISA with the EBNA-1 fusion proteins and those determined by a conventional anticomplement immunofluorescence test which is being widely performed with Raji cells for the purpose of research and clinical diagnosis. The advantage of the ELISAs for seroepidemiologic studies on Epstein-Barr virus was demonstrated by sensitive detection of marginal immunoglobulin G antibody to the EBNA-1 domain in serum samples from patients with infectious mononucleosis.     

Does the deletion within T cell receptor β-chain gene of NZW mice contribute to autoimmunity in (NZB × NZW)F1mice?

To determine the transacting genetic factors of NZW contributing to the development of autoimmune disease in (NZB X NZW)F1 (B/W F1) mice, we examined the relationship between the T cell receptor beta chain gene deletion and the severity of autoimmune manifestations in 76 B/W F1 X NZB backcross mice. Very high association between the T cell receptor beta chain gene deletion and the development of autoimmune manifestations including the production of IgG anti-DNA antibodies and circulating retroviral gp70 immune complexes was observed, indicating that a defect in the NZW T cell receptor beta chain gene or a locus closely linked to it contributes to the autoantibody formation in B/W F1.     

Blood Flow and Leukocyte Adhesiveness Are Reduced in the Microcirculation of a Peritoneal Disseminated Colon Carcinoma

Dynamic behavior of leukocytes in the microcirculation of solid tumor tissue was visualized using a fluorescent labeling technique combined with the use of a real-time confocal laser-scanning microscope (CLSM) system. Colon tumor cells (RCN-9) were inoculated into the peritoneal cavity of male Fischer 344 rats. Tumor-free rats were similarly injected with physiological saline (intraperitoneally). Ten days after tumor inoculation, the mesentery was exteriorized and subjected to vital microscopic observation under the CLSM system. Leukocytes were labeled with rhodamine 6G (100 g kg^–1, intravenously), and their behavior within the microvessels (10–30 m in diameter) was analyzed both in the solid tumor tissues and the normal mesentery. Wall shear rate was calculated from the measured values of vessel diameter and erythrocyte flow velocity. In tumor microvasculature of tumor-bearing rats, the centerline erythrocyte velocity (0.73 ± 0.58 mm s^–1, mean±standard deviation) and wall shear rate (210 ± 151 s^–1 were significantly lower than those of the tumor-free rats (1.27 ± 0.83 mm s^–, 344 ± 236 s^–1, respectively). Despite such reduced flow conditions, flux of the rolling leukocytes as well as density of the adhered leukocytes both decreased significantly in tumor microvasculature as compared with normal controls. The methods developed in this work show promise in improving our understanding of tumor biology and pathophysiology. © 1998 Biomedical Engineering Society. PAC98: 8722Fy, 8745Hw, 8745Ft, 8764-t, 4262Be