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Rat interleukin-5 (IL-5) cDNA was subcloned from peritoneal cells collected 4 h after intraperitoneal injection of Ascaris suum antigen solution into the immunized rats. Cysteine proteinase-deleted (CPd) rat IL-5 recombinant virus was constructed by inserting rat IL-5 cDNA into CPd virus having a deletion in the cysteine proteinase gene of the silkworm Bombyx mori nuclear polyhedrosis virus. On infection with the CPd rat IL-5 recombinant virus, the silkworm B. mori larvae produced rat IL-5 as a dimeric form in hemolymph. Recombinant rat IL-5 was purified more than 95.5% by anion-exchange chromatography and hydrophobic chromatography. The purified recombinant rat IL-5 promoted the proliferation of T88-M cells in a concentration-dependent manner, and its effect was inhibited by an anti-murine IL-5 neutralizing polyclonal antibody. When bone marrow cells from normal rats were incubated with recombinant rat IL-5 in medium containing methylcellulose, the colony formation by eosinophilic cells was induced. Furthermore, when rat peritoneal eosinophils were incubated with recombinant rat IL-5, the spontaneous decrease in the eosinophil viability was inhibited in time- and concentration-dependent manners. In addition, the recombinant rat IL-5-induced eosinophil survival was inhibited by an anti-murine IL-5 neutralizing polyclonal antibody. These findings suggest that rat IL-5 acts as B-cell growth factor II (BCGF-II), eosinophil differentiation factor (EDF), and eosinophil survival-enhancing factor.

Pre- and postoperative complications of 525 cases of femoral neck fractures in elderly patients were studied. The mean age was 81.5 years. Preoperative complications were found in 94.5% of the patients. Circulatory and respiratory complications were 68.4% and 29.7%, respectively. Dementia was present in 55.6% of the patients. Operations for fractures were performed under spinal anesthesia only or under both spinal and epidural anesthesia. We tried to avoid hypotension and hypoxia during operations and postoperative periods under pulse oximeteric monitoring. In the postoperative period, circulatory and respiratory diseases exacerbated or newly developed in 4.4% and 5.7% of all cases, respectively. Postoperative mortality within a month was 1.0%, and it was 3.6% within a year. Many elderly patients with femoral neck fractures had preoperative complications, but postoperative complications could be avoided by careful management during pre- and postoperative periods.

For patients with small hepatocellular carcinomas (HCCs) treated by percutaneous ethanol injection (PEI) therapy, dynamic MRI has been performed to evaluate the therapeutic efficacy at our institute. In this pictorial essay, we illustrate the various dynamic MR findings of HCCs after PEI therapy, including complete necrosis, partial necrosis, local recurrence, and pathologic conditions such as arterioportal shunt and contractive changes of hepatic parenchyma. We also present the limitation of dynamic MRI in the evaluation of therapeutic effectiveness of PEI therapy.

To determine whether there is a close temporal relationship of liver disease to serum IgG and/or IgM antiribosomal P0 protein antibodies (anti-P0) and central nervous system (CNS) lupus in patients with systemic lupus erythematosus (SLE).The study included 70 patients with active SLE. Of these, 30 had IgG and/or IgM anti-P0 and 14 had CNS lupus other than psychiatric disease (nonpsychiatric CNS lupus). Of these 14 patients, 11 had anti-P0. Laboratory manifestations of liver disease were retrospectively analyzed.Liver disease not attributed to any cause other than SLE (SLE liver disease) was present in 8 of the 11 patients with anti-P0 with nonpsychiatric CNS lupus (72.7%), in none of the 19 patients with anti-P0 without nonpsychiatric CNS lupus (0%), and in one of the 40 patients without anti-P0 (2.5%). The prevalence of SLE liver disease was significantly greater in patients with anti-P0 with nonpsychiatric CNS lupus than in the other 2 groups (p0.0001). Mean levels of liver enzymes (lactate dehydrogenase, glutamic oxaloacetic transaminase, glutamate pyruvate transaminase, gammaglutamyl transpeptidase) were significantly higher in patients with anti-P0 with nonpsychiatric CNS lupus than in the other 2 groups. Serial studies in 3 patients showed that the appearance of anti-P0 and liver dysfunction slightly preceded the onset of nonpsychiatric CNS lupus.Anti-P0 may be related to the pathogenesis of CNS lupus and SLE liver disease found simultaneously in SLE. The appearance of anti-P0 and liver dysfunction may predict onset of CNS lupus.

From January 1996 to August 1997, 24 patients with advanced hepatocellular carcinoma (HCC) equal to or more than 2 cm (mean +/- SD; 4.1 +/- 3.0 cm) in main tumor diameter were treated by SMANCS-TAE (20 cases) or SMANCS-TAI (4 cases) combined with PEI. Six cases had solitary lesion, 16 cases had multiple lesions, and 2 cases had massive lesions. After this combination therapy, 21 of 24 cases had complete tumor necrosis. During 3 to 19 months follow up period, 12 cases had cancer-free survival (SMANCS-TAI; 3 cases), and 9 cases had tumor recurrences (3 cases were local recurrences and 6 cases involved new lesions). Two cases died of hepatic infarction and cancer death, however, the remaining 22 cases were surviving. SMANCS-TAE combined with PEI is useful treatment for advanced large or multiple HCC lesions in patients who are poor surgical risks.

A 44-year-old woman was admitted to our hospital complaining of dyspnea. A chest X-ray film obtained on admission showed bilaterally shrunken lungs, and peripheral bundle-like and linear shadows. A chest CT scan revealed marked thickening of bronchovascular bundles and low lung volumes. Mild dryness of the mouth, and the results of a Rose-Bengal test, Schirmer test, and sialography led to the diagnosis of primary Sjögren's syndrome. Corticosteroid pulse therapy was followed by slight improvement. To determine the pathological diagnosis and to plan further therapy, video-assisted thoracoscopic lung biopsy was done. Examination of the biopsy specimen revealed alveolitis and infiltration of lymphocytes, which suggested active interstitial pneumonia. Therapy with corticosteroids and the immunosuppressant azathioprine was followed by marked improvement.

Extracranial internal carotid artery aneurysm is rare. Most cases are due to spontaneous or traumatic dissection of the cervical internal carotid artery. Here we report a case of surgically treated extracranial internal carotid artery (ICA) aneurysm. A 74-year-old man noticed a pulsatile mass just below the left mandibular angle. Intravenous digital subtraction angiography revealed multiple aneurysms in the systemic arteries, including the aortic arch, abdominal aorta and left extracranial ICA. It was decided to treat the aneurysms of the aortic arch and of the abdominal aorta conservatively. Cerebral angiography, however, showed a saccular aneurysm which projected latero-posteriorly at the C2 level of the left extracranial ICA. Although the patient had no previous ischemic event, we decided to treat this aneurysm surgically in view of the risk of cerebral ischemia caused by intraaneurysmal thrombus formation or rupture of the aneurysm by neck injury. The operation was performed under mild hypothermal general anesthesia. Electroencephalography was carried out during the operation. A skin incison was made from the anterior border of the sternocleidomastoid muscle to the pretragal region to expose the parotid gland. This skin incision, elevation of the parotid gland and division of the digastric muscle were useful for exposing the distal portion of the extracranial ICA. After trapping of the aneurysm, it was punctured and collapsed by aspiration and the dome was excised at its neck. The ICA was then reconstructed by suturing the cut neck of the aneurysm. Patency of the ICA was confirmed by postoperative angiography. The postoperative course was smooth except for hoarseness, which was caused by damage to a minor branch of the vagus nerve during exposure of the aneurysmal dome.

We studied length of survival and related clinical findings in 715 inpatients with collagen-vascular diseases (1984 through 1994), the diagnostic Kaplan-Meier analysis showed that patients with polymyositis/dermatomyositis and those with systemic sclerosis did not survive as long as those with other types of collagen-vascular disease. Of the patients who died 37% died of respiratory failure due to interstitial lung disease. Patients with interstitial lung disease had better outcomes than did those with idiopathic interstitial pneumonia: they were younger, had higher initial vital capacities, and fewer episodes of acute exacerbation of lung disease than did those with idiopathic interstitial pneumonia. Among patients with interstitial lung disease, those who died of polymyositis/dermatomyositis did so within 1 year, but those who died of systemic sclerosis lived longer. Interstitial lung disease is an important prognostic factor in collagen-vascular disease, and needs further evaluation.

To determine the role of interstitial lung disease (ILD) in the outcome of polymyositis-dermatomyositis (PM/DM), we studied 41 patients who had radiographic evidence of ILD among 51 patients with PM/DM. The patients were divided into 3 groups according to therapy: progressive, no change, or improved. Those classified as progressive had significantly higher rates of skin and lung symptoms, milder muscle symptoms, and lower levels of muscle enzymes than the other 2 groups, and none was positive for the anti-Jo-1 autoantibody. Nine patients with DM died of respiratory failure; they had low serum creatine kinase levels, no anti-Jo-1 antibodies, and a rapidly progressive course before death. Autopsy findings were obtained in 7 patients, and all had diffuse alveolar damage as the main pulmonary histological finding. A subgroup of patients with PM/DM-ILD have a poor prognosis, and ILD in PM/DM is an important prognostic factor.

The purpose of this study was to evaluate the protective effects of a neuroselective calcium antagonist, nimodipine on spinal cord ischemia during and after thoracic aortic cross-clamping.Thirty adult dogs underwent 60 minutes of thoracic aortic cross-clamping via a left thoracotomy. The dogs were randomized into 3 groups (n = 10) and received either intravenous control (normal saline), sham (polyethylene glycol) or nimodipine solution during a period of 150 minutes. Spinal cord perfusion (SCP) was directly monitored using a laser doppler flowmeter. After 48 hours, neurologic status was assessed using Tarlov scores and the spinal cords evaluated histologically for evidence of ischemia (grades 1-4: severe to mild ischemia).Twenty-six dogs survived the operation. Proximal (carotid) blood pressure increased 30-40% and cerebrospinal fluid (CSF) pressure increased 50% during cross-clamping for all 3 groups. The SCP decreased predictably during cross-clamping in all dogs but after unclamping, the nimodipine group had significantly less hyperperfusion than the saline and sham control groups (30 min after unclamping, control: 74.1 +/- 12.6 ml/min, sham: 51.8 +/- 4.15 ml/min, nimodipine: 33.1 +/- 3.9 ml/min, p = 0.04). This hyperperfusion phenomenon correlated with adverse neurologic (Tarlov score) outcome (p = 0.01). Paraplegia rates were 78% (control), 70% (sham) and 71% (nimodipine) (p = NS). The histologic grades of the spinal cords from those dogs which received nimodipine tended to correspond to better tissue preservation (control: 1.72 +/- 0.49, sham: 1.75 +/- 0.46, nimodipine: 2.14 +/- 0.56, p = NS).Nimodipine used as single agent therapy failed to show a statistically significant clinical neurologic benefit. However, nimodipine significantly decreased postischemic reperfusion hyperemia in the spinal cord as measured by laser doppler flowmetry. This reduced hyperperfusion, which significantly correlated with functional outcome, may be responsible for dampening neural cell damage. Thus, nimodipine should be considered as an adjunct to a multimodality approach in the prevention of spinal cord ischemia during thoracic and thoracoabdominal aortic reconstructions.

Our surgical experiences in 9 patients who required steroid treatment for systemic diseases before, during and after the open heart surgery were reviewed. Subjects included 3 patients with systemic lupus erythematodes, 3 with aortitis syndrome, 1 with Behçet disease and 1 with rheumatoid arthritis. Cardiovascular lesion was aortic valve regurgitation in 2, Stanford A aortic dissection in 1 and ischemic heart disease in 3 patients. Duration of morbidity for systemic diseases before the surgery ranged between 0 nd 102 months, with a mean of 36 months. Steroid treatment was continued for 4 to 216 months (mean 70+/-76 months) before the surgery at a dose of 5-40 mg per day for conversion into prednisolone. In principal, methylprednisolone was given during the surgery, and the prednisolone was given at a dose of 20-140 mg per day on the day of operation or on the first postoperative day. Surgical procedures included a aortic valve prosthesis with Dacron cloth skirt implantation in 1 patient, surgical angioplasty of the left main coronary ostium in 1 and internal thoracic arteries grafting in 2 patients. Hospital mortality was 1 patient due to low cardiac output syndrome. Acute renal failure occurred in 2 patients with systemic lupus erythematodes, and wound complication was observed in 2 patients. In our experience, appropriate treatment for systemic diseases, timing of surgery and continuation of steroid treatment at an appropriate dose during and after the surgery seemed very important such as surgical procedure in order to prevent postoperative complications such as periprosthetic leakage and failure of anastomosis.

We have reviewed 28 tibial lengthenings in 14 patients with achondroplasia at an average age of 15 years, and compared the effectiveness of physiotherapy and an orthosis in preventing an equinus deformity. Physiotherapy of 15 min a day was ineffective even when the patients were able to walk. An orthosis worn for 16 h a day prevented equinus deformity up to at least 50% of lengthening, and the difference from physiotherapy was significant at more than 30% of lengthening.

It has been reported that the high flow and pressure perfusion produced the brain damage during selective cerebral perfusion. This time we studied the mechanism of this brain damage with mock circulation. We made the mock circulation system of brain with the hard shell reservoir as cranium, and with the triple soft bags as brain tissue, involving into reservoir. We designed the control group that intracranial pressure (ICP) was 0 mmHg at pump off, and the increasing intracranial pressure (IICP) group that ICP was 10 mmHg at pump off. We measured the flow-pressure relationship in the control and IICP group, and then stenosis in outflow. In results, the flow and pressure in both the inflow and outflow side increased significantly (p0.001) in control groups, as pump flow increased. The changes of the flow and pressure in IICP group showed a same tendency to the control group. Moreover, both the inflow volume into bag and the outflow volume from bag decreased as pump flow increased stepwisely. The pressure in both inflow and outflow side increased significantly and the volume of the inflow side in IICP group showed a tendency to decrease, compared with the control. The stenosis in the outflow side produced the significant increase in the pressure of both inflow and outflow side, and intracranium, with the same pump flow as the control without stenosis. In conclusion, the high flow perfusion produced the increase of the several pressure in intracranial and extracranial vessels. Moreover, the high flow perfusion produced the decrease of the intracranial blood volume cerebral blood flow. The high flow perfusion does not necessarily contribute to the cerebral tissue perfusion. The stenosis at the side of venous return produced relative high perfusion. This result suggests that the venous return should be taken care of during the selective cerebral perfusion.

The sites of action of endogenous and inhaled nitric oxide (NO) were reassured during hypoxic pulmonary vasoconstriction. Lungs of 21 adult cats were perfused in situ with autologous blood in zone-3 conditions. Capillary pressures were measured by the double-occlusion techniques and pressures in arterioles and venules 70-100 microns in diameter were measured by the servo-null micropuncture technique, both during normoxia (FiO2 = 0.3) and during hypoxia (FiO2 = 0.02). The effects of NG-nitro-L-arginine methyl ester (L-NAME, 10 mg/kg), an inhibitor of NO synthase, and of inhaled NO (5-100 ppm) were also measured. The PO2 of the prefusate decreased from 187.6 +/- 5.3 mmHg during normoxia to 25.7 +/- 1.3 mmHg during hypoxia, and further decreased to 20.8 +/- 2.2 mmHg during hypoxia with 50 ppm NO (p0.05, compared with hypoxia only). Increases in pulmonary vascular pressure drop in response to hypoxia were 4.8 +/- 1.0 cmH2O and 9.1 +/- 1.4 cmH2O in non-treated and L-NAME-treated lungs, respectively (p0.05). L-NAME significantly increased hypoxic construction in the venous segment. The concentration of exhaled NO increased from 13 +/- 4 ppb during normoxia to 18 +/- 4 ppb during hypoxia (p0.1). Inhaled NO lowered not only pulmonary artery pressure but also capillary pressure in a dose-dependent manner, which reduced hypoxic pulmonary vasoconstriction. Pulmonary veins were more sensitive to inhaled NO than were arteries. Inhaled NO (50 ppm) dilated vessels smaller than 70 to 100 microns in diameter, by 39% (p0.05), and dilated venules greater than 100 microns in diameter by 26% (p0.05), but did not significantly dilate arterioles greater than 100 microns in diameter (11%). Inhaled NO did not significantly change the ratio of wet weight to dry weight. We conclude that both endogenous and inhaled NO attenuate hypoxic pulmonary vasoconstriction, with significant pulmonary venous dilation. The main site of action of inhaled NO is vessels smaller than 100 microns in diameter and venules greater than 100 microns in diameter. Inhaled NO (5-100 ppm) does not cause interstitial edema.

In 715 patients with collagen vascular diseases, interstitial lung disease and pulmonary hypertension were found to be important causes of death (37.5% and 6%, respectively). The prognosis of interstitial lung disease associated with collagen vascular disease was better than that of idiopathic interstitial pneumonia; patients with the latter were more likely to experience exacerbations. A distinct subgroup of patients with dermatomyositis and interstitial lung disease with a rapidly progressive course was characterized by mild muscle symptoms, low levels of creatine phosphokinase and negative tests for anti-Jo-1 antibody. CT scores and analysis of bronchoalveolar lavage fluid proved to be of some value in predicting outcome. Measurement of IL-6 in bronchoalveolar lavage fluid and local immunostaining for this pro-inflammatory cytokine were helpful in evaluating responses to therapy.

Magnetic compound action fields (CAFs) over the right arm were measured from 63 sensor positions with two 7-channel SQUID gradiometer systems following electrical stimulation of the index and little fingers as well as the ring finger separately. The wave forms of the CAFs were primarily biphasic, corresponding to the depolarization and repolarization currents of the stimulated nerves. Maximum amplitudes of the CAFs were 60-140 fT for the index finger stimulation and 40-90 fT for the little finger stimulation. The field mapping of the CAFs revealed a propagating quadrupolar pattern with different distributions for the index and little fingers. The results agree with the anatomical location of the median and ulnar nerves for the index and little finger stimulation respectively. The isofield maps, due to ring finger stimulation, showed complex patterns as a result of simultaneous activation of the median and ulnar nerves. By comparing the amplitudes of the maxima of the CAFs due to index finger stimulation with those after median nerve stimulation at the wrist, the numerical ratios of the constituent digital nerve fibers for the index finger within the median nerve at the wrist were estimated. The ratios of 0.14-0.41 (mean 0.27), determined with measurement of the CAFs, are fairly consistent with those calculated from the reported histological data.

p53 gene mutation was examined in 9 pineal parenchymal tumors, 4 pineoblastomas and 5 pineocytomas, by the immunohistochemical and the polymerase chain reaction-mediated single strand conformation polymorphism (PCR-SSCP) analyses. In each case, immunohistochemical analysis revealed no positive staining for p53 protein with either PAb1801 or DO-1 antibody and PCR-SSCP analysis revealed no abnormal migration in exons 5 to 8 of the p53 gene. These findings suggested that p53 gene mutation is rarely related with the tumorigenesis of pineal parenchymal tumors.

Recently many kinds of large-scale planar lightwave circuit (PLC) have been developed for use in optical communication systems. Since the characteristics of large scale PLCs depend on the losses in waveguides, PLC performance can be improved by reducing such losses. The propagation losses in silica-based waveguides have been evaluated by using long waveguides such as that shown in Fig. 1. The lowest loss value ever reported with silica-based long waveguides is 3.5 dB/m [1]. This was obtained in a 1.6-m long waveguide with a relative index difference Δ of 0.75%. It was deduced that the main reason for the loss is the scattering ascribed to the fluctuation of the refractive index and the core-cladding interface. This means that lower loss waveguides can be fabricated using lower Δ waveguides, though these require larger bending radii, and therefore a lager circuit size. This indicates that the minimum Δ value should be determined by taking account of the size of the substrate on which the long waveguides are laid out. Here we report the fabrication and loss characteristics of a 10-m long waveguide with a Δ of 0.45 % which has a very low loss of 1.7 dB/m.

We studied the influence on cerebral hemodynamics with 10 pigs, weighing 25 to 30 kg, when the temperature of perfusion blood changed in both rapid cooling and rewarming, and in slow them. As for the protocol of temperature, we decided that rapid change was the large temperature gradient of more than 0.5 degree C/min, and slow change was the small gradient of less than 0.3 degree C/min. Cardiopulmonary bypass (CPB) was established with a flow rate of 60 ml/kg/min, and core cooling was performed until the temperature of the returned blood from internal jugular vein reached 25 degrees C/min. For selective cerebral perfusion (SCP), blood was infused into aortic arch with the clamp of descending aorta at the temperature of less than 20 degrees C. We measured regional tissue cerebral blood flow (TCBF), intracranial pressure (ICP), carotid arterial flow (CAF), and carotid arterial pressure (CAP), and PCO2 in both CPB and SCP. Rapid cooling during CPB caused an elevation in CAP, and marked decrease in CAF, ICP, and PCO2. In contrast, rapid rewarming caused the significant increase in CAF, ICP. Slow change did not cause marked difference in CAP, CAF, and ICP, and PCO2. Moreover, TCBF was not significant in both rapid and slow changes. On the other hand, rapid change in SCP caused a significant decrease in CAP, significant difference in CAF, ICP. Slow change did not cause significant difference in them as same as in CPB. In conclusion, we presume that the influence on cerebral hemodynamics is less in slow cooling and rewarming than in rapid changes.

A 62-year-old man who had undergone left lingual segmentectomy for pulmonary tuberculosis developed left chronic localized pleural empyema with multiple bronchial fistulae in the region of surgical gauze left in the thoracic cavity. We surgically removed the gauze and fenestrated the empyema. After disinfection of the region of suppuration, small fistulae which were less than 2 mm in diameter were closed by fibrin-glue-packing and consolidation of the orifices using 40% silver nitrate solution. Two and one-half months later a second operation was performed. Residual large fistulae were closed by fibrin-glue-packing and suturing of their orifices, and the empyema space was then obliterated by muscle flap plombage. The patient's postoperative course was good and the empyema was completely cured with this treatment.

Comparison of long term clinical results after aortic valve replacement with 19 mm or 21 mm vs. 23 mm or larger bileaflet prostheses has not yet been reported. Between December 1979 and September 1993, 80 consecutive patients who underwent isolated aortic valve replacement at Niigata University using a standard St. Jude Medical valve were assigned to small size group (19 mm and 21 mm, n = 34) or to large size group (23 mm or larger, n = 46). In the small size group, patient's age was older, body surface area smaller, female patients and calcified aortic stenosis were dominant (all p0.01). The left ventricular systolic dimension was shorter (p0.001), while the cardiothoracic ratio was similar to that of the large size group. All patients received warfarin treatment, and target thrombotest level was 15 to 25% (equivalent to INR 1.6 to 2.1). Actuarial survival rates including hospital death in the small size group (94% at fifth postoperative year) were comparable to those in the large size group. Cerebrovascular event occurred in two patients with the small size prosthesis (1.3%/pty) and three with larger prosthesis (0.9%/pty). Major hemorrhagic complication was not observed in either group. No significant difference was noticed in the proportion free from valve-related morbidity. In the patients with aortic stenosis (n = 41), the left ventricular posterior wall thickness decreased from 15 mm preoperatively to 11 mm late post surgery in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Two cases were operated on simultaneously for coronary revascularization and lung resections for cancer. Case 1 was a 79 year-old man, diagnosed with two vessels coronary artery disease and squamous cell carcinoma of left lower lobe. At the end of aortocoronary bypass grafting to LAD and first diagonal branch using saphenous vein, median sternotomy was closed, and lower lobectomy was performed through left posterolateral standard thoracotomy. Case 2 was a 65 year-old man who underwent aortocoronary bypass grafting to LAD first and left lingular segmentectomy via median sternotomy simultaneously. We concluded that a simultaneous operation was definitively and ideally a preferable method in most selected cases. The order of two operations for coronary artery and lung was also discussed.

This study was undertaken to clarify characterization on cerebral hemodynamics during deep hypothermic selective perfusion (SCP) in 18 pigs. Besides, the changes on cerebral hemodynamics were investigated with obstruction to venous drainage due to the clamp of superior vena cava (SVC) cannula. For SCP, blood was infused into aortic arch with the clamp of descending aorta, during 90 minutes at 20 degrees C. We measured regional cerebral blood flow (CBF), intracranial pressure (ICP), and carotid arterial flow (CAF), and carotid arterial pressure. The carotid arterial pressure as perfusion pressure was not significantly correlated with CAF, CBF and ICP. Although CAF increased as pump flow rate increased, the relationship between pump flow and CBF was not significant. Moreover, SVC pressure showed a tendency to increase, as CAF increased. Both ICP and internal jugular vein pressure (IJVP) were significantly (p0.01) increase, and CAF was significantly (p0.05) decrease with the clamp of SVC cannula. On the other hand, both ICP and IJVP were significantly decrease, and both CAF and CBF were increase, without unclamp of SVC cannula. The results suggest that cerebral autoregulation is intact during deep hypothermic SCP, and hyperperfusion cause the increase of shunt flow in extracranial area, and besides, the increase of ICP with obstruction to venous drainage cause decrease in cerebral blood flow.

Introduction This study aimed to elucidate the relationship of night duty, on-call duty, average working hours and job stress to insomnia among hospital doctors. Methods Questionnaires including job factors and the Brief Job Stress Questionnaire, were sent to all alumni of Asahikawa Medical University (n=2937). Of the 568 medical doctors who responded, 430 were hospital doctors; 424 questionnaires were analysed after excluding six because of missing values. Insomnia was estimated using the Athens Insomnia Scale (≥6 points). Explanatory variables were sex, age, specialty, location, night duty, on-call duty, average working hours, job effort, level of job control, support from supervisors, support from co-workers and support from family/friends. Logistic regression analysis was used; sex, age and specialty were forced into the model and other variables were entered into the model in a reverse stepwise manner. Results In the stepwise logistic regression analysis, night duty had a significantly higher OR for insomnia (OR=2.00; 95% CI 1.24 to 3.27). A high levels of job control and high job support had a significantly lower ORs (OR=0.76, 95% CI 0.68 to 0.86; OR=0.88, 95% CI 0.79 to 0.98, respectively). Average working hours was selected in final model but the relationship was not significant. The other variables were not selected in the final model. Conclusion Night duty may induce insomnia, but a high level of job control and a high level of support from co-workers may have a protective effect against insomnia among hospital doctors.

Hepatocyte growth factor (HGF) has mitogenic and unique morphoregulatory functions, and is considered to act as a hepatotrophic and a renotrophic factor for regeneration of the liver and kidney subjected to various insults. We have now obtained evidence that heparin is a potent inducer of HGF production. The addition of heparin to a culture of MRC-5 human embryonic lung fibroblasts increased the HGF concentration in the conditioned medium, in a dose-dependent manner. The maximal stimulation was obtained at 1 microgram/ml heparin and stimulation was 4-fold compared to control cultures. The rate of HGF synthesis in MRC-5 cells, as measured by pulse-labeling with [35S]methionine, and subsequent immunoprecipitation of HGF from both conditioned medium and a cell lysate, was 3-4-fold stimulated by 1 microgram/ml heparin, whereas heparin apparently had no significant effect on the HGF mRNA level. The stimulatory effect of heparin on HGF production was evident in various types of cells, such as MRC-9, IMR-90, and WI-38 human embryonic lung fibroblasts, human skin fibroblasts, HL-60 human promyelocytic leukemic cells and human umbilical vein endothelial cells. In addition to heparin, heparan sulfate also stimulated HGF production, albeit to a lesser extent than heparin; 1.7-fold stimulation with 2 micrograms/ml heparan sulfate. However, other glycosaminoglycans, such as hyaluronic acid, chondroitin sulfate, dermatan sulfate, keratan sulfate, and keratan polysulfate, had no stimulatory effect on HGF production.(ABSTRACT TRUNCATED AT 250 WORDS)

We reviewed 224 patients, who underwent kidney transplantation to investigate relationship between aseptic necrosis (AN) and administration of steroid, Cyclosporin A (CsA), body weight gain. We classified patients into 4 groups by the type of immunosuppressant: the AP group had received Azathioprine (AZ) + Prednisolone (Pre); the CP group, CsA + Pre; the ACP group, AZ + CsA + Pre; and others. There were total 24 AN patients (10.7%). The incidences of AN is 18% in the CP group, 9.3% in the AP group and 0% in the ACP group. In the AP group, weight gain at 1 and 2 month after transplantation and cumulative steroid dose at 3, 4, 5 and 6 month after transplantation correlated with AN. In the patients with AN of the CP and ACP groups, CsA doses per kilogram of body were higher than those in patients without AN at 5, 6 and 12 month after transplantation. In the CP group, the incidence of AN is significantly higher, and administration dose of CsA was higher than that in the ACP group. However steroid dose and body weight gain were lower in the CP group. Therefore AN was associated with CsA in the CP group. In contrast, AN correlated with weight gain and early high cumulative steroid dose administration in the AP group.

Two types of cDNA encoding PACAP receptors were isolated from the rat brain cDNA library by homology screening with a cDNA probe for VIP receptor. Nucleotide sequence analysis indicated that these two types of receptor mRNA were generated by alternative splicing mechanisms. These two cloned cDNAs were introduced into CHO cells respectively. Resultant transformants showed specific binding to [125I]PACAP27 which was displaced by unlabeled PACAP27 but not by VIP. Thus, these receptors are two subtypes of Type I PACAP receptor (Type I-A and Type I-B). The amino acid sequences of rat PACAP receptors deduced by the cDNAs showed a remarkable similarity with rat receptors for VIP, secretin, glucagon, and GHRH. A 6.5 kb significant hybridizing signal of the PACAP receptor mRNA was detected in the rat brain, and slight signal was also detected in the lung and the liver.

The aim of this study was to determine the efficacy of color Doppler sonography in the diagnosis of portal vein thrombosis in patients with primary hepatocellular carcinoma. The findings on angiography were used as the gold standard for diagnosis.We compared the findings on color Doppler sonograms and hepatic angiograms in 18 patients with hepatocellular carcinoma and portal vein thrombosis and in 22 patients with hepatocellular carcinoma without portal vein thrombosis. In most patients, tumor-related thrombus of the portal vein was confirmed by autopsy or surgery. The sonographic criteria for diagnosing portal vein thrombosis included nonvisualization of portal vein flow, pulsatile flow in the thrombus, arterioportal shunts, and cavernous transformation of the portal vein.Nonvisualization of portal vein flow was the predominant color Doppler finding in all patients with portal vein thrombosis. Other flow abnormalities overlapped the finding of nonvisualization of portal vein flow in 10 of 18 patients with portal vein thrombosis. The sensitivity of color Doppler sonography was 100% for nonvisualization of portal vein flow, 89% for detection of pulsatile flow in the thrombus, 60% for detection of arterioportal shunts, and 100% for detection of cavernous transformation. Among these findings, pulsatile flow in the thrombus was diagnostic for pathologically proved neoplastic thrombi in the main portal vein; sensitivity and specificity were 89% and 100%, respectively, and accuracy was 96%. No portal vein that appeared normal on color Doppler sonograms was thrombosed on arteriograms.We conclude that color Doppler sonography is a useful means of imaging the vascular extension of a tumor-based thrombus and an accurate means of screening for portal vein thrombosis.

A case of a 66-year-old man with ischemic heart disease and lung cancer is reported. Chest roentgenogram revealed an irregular 2.8 x 2.0 cm mass in the right upper lobe. Coronary angiography showed 75-90% stenosis of the left anterior descending artery, and these lesions was suspected to cause perioperative myocardial infarction. A concomitant operation of aorto-coronary bypass graft and right upper lobectomy was performed through median sternotomy. A concomitant operation must be considered to be definitive and ideally preferable in selected cases.

Since the expression of genes for platelet-derived growth factor (PDGF)-A and PDGF beta-receptor are reciprocally regulated in vascular wall cells after balloon injury, we have investigated the ability of specific vasoactive molecules or growth factors to reproduce the injury pattern of gene expression in cultured rat smooth muscle cells (SMCs) and assessed the effect of inactivating alpha-thrombin on injury-induced expression of PDGF-A mRNA by vascular wall cells in vivo. The molecules investigated, to which vascular SMCs may be locally exposed after mechanical injury, included vasoactive factors (alpha- and beta-adrenergic agonists, serotonin, histamine, angiotensin II, and endothelin) and growth factors (PDGF-AA, PDGF-BB, basic fibroblast growth factor, insulin-like growth factor, epidermal growth factor, and alpha-thrombin). In cultured rat SMCs, only alpha-thrombin (0.1-100 nM), among these compounds, produced the pattern of transiently increased PDGF-A and decreased PDGF beta-receptor mRNA. PDGF-B chain mRNA levels remained undetectable in these cultured SMCs. The dependence of these changes in gene expression on the proteolytic activity of alpha-thrombin was shown by the interruption of altered gene expression or DNA synthesis after incubating the cultured SMCs with covalently inactivated alpha-thrombin using D-Phe-Pro-Arg chloromethyl ketone, a synthetic direct active-site irreversible inhibitor of alpha-thrombin. Continuous intravenous infusion of this synthetic antithrombin into baboons for 6 hours (100 nmol/kg per minute maintaining constant plasma levels of 3.0 +/- 0.5 microns/ml) after inducing balloon-catheter arterial injury also prevented the threefold increase in expression of PDGF-A mRNA characteristically exhibited by untreated mechanically injured vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

The Japanese Interferon Study Group (JISG) is a research organization formed by 30 special hospitals for organ transplantation. A joint multi-centre, double-blind trial was conducted in order to investigate the efficacy of human interferon-beta (HuIFN-beta) against serious cytomegalovirus pneumonitis in kidney recipients.

A multicentre study of ABO incompatible kidney transplantation using Biosynsorb was started in Japan in November 1989. A total of 51 cases were registered comprising 23 cases of A incompatibility, 26 cases of B incompatibility and two cases of AB incompatibility. The removal of antibodies (IgG and IgM) was carried out using Biosynsorb in 16 cases, plasmapheresis in four cases and use of both combined in 31 cases. The treatment using Biosynsorb was repeated 3.4 times on average. Serum titres of anti-A (IgG and IgM) antibodies decreased to 4.9 +/- 5.0 and 2.7 +/- 1.7 and for anti-B titres decreased to 2.8 +/- 3.5 and 2.4 +/- 3.2. Rejection was found in 33 cases: hyperacute one, accelerated acute five, and acute 27. In two cases rejection was developed concomitantly with a steep elevation in antibody titres. Three patients died, two with functioning grafts. Eight grafts were lost. Patient and graft survivals at 2 years were 94.1% and 84.3%, respectively. From these results it is concluded that: 1. Biosynsorb and plasmapheresis are effective in removing anti-A and anti-B antibodies; 2. graft and patient survivals are similar to those in ABO compatible cases; 3. anti-A and anti-B titres less than 16 are recommended at the time of transplantation; 4. anti-A and anti-B titres higher than 128 may be considered as a risk factor for rejection in the early stages after transplantation.

A multicentre study of ABO incompatible kidney transplantation using Biosynsorb was started in Japan in November 1989. A total of 51 cases were registered comprising 23 cases of A incompatibility, 26 cases of B incompatibility and two cases of AB incompatibility. The removal of antibodies (IgG and IgM) was carried out using Biosynsorb in 16 cases, plasmapheresis in four cases and use of both combined in 31 cases. The treatment using Biosynsorb was repeated 3.4 times on average. Serum ti-tres of anti-A (IgG and IgM) antibodies decreased to 4.9 ± 5.0 and 2.7 ± 1.7 and for anti-B titres decreased to 2.8 ± 3.5 and 2.4 ± 3.2. Rejection was found in 33 cases: hyperacute one, accelerated acute five, and acute 27. In two cases rejection was developed concomitantly with a steep elevation in antibody titres. Three patients died, two with functioning grafts. Eight grafts were lost. Patient and graft survivals at 2years were 94.1% and 84.3%, respectively. From these results it is concluded that: 1. Biosynsorb and plasmapheresis are effective in removing anti-A and anti-B antibodies; 2. graft and patient survivals are similar to those in ABO compatible cases; 3. anti-A and anti-B titres less than 16 are recommended at the time of transplantation; 4. anti-A and anti-B titres higher than 128 may be considered as a risk factor for rejection in the early stages after transplantation.

The Japanese Interferon Study Group (JISG) is a research organization formed by 30 special hospitals for organ transplantation. A joint multi-centre, double-blind trial was conducted in order to investigate the efficacy of human interferon-beta (HuIFN-beta) against serious cytomegalovirus pneumonitis in kidney recipients.