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The known mammalian glycerophosphodiester phosphodiesterases (GP-PDEs) hydrolyze glycerophosphodiesters. In this study, two novel members of the mammalian GP-PDE family, GDE4 and GDE7, were isolated, and the molecular basis of mammalian GP-PDEs was further explored. The GDE4 and GDE7 sequences are highly homologous and evolutionarily close. GDE4 is expressed in intestinal epithelial cells, spermatids, and macrophages, whereas GDE7 is particularly expressed in gastro-esophageal epithelial cells. Unlike other mammalian GP-PDEs, GDE4 and GDE7 cannot hydrolyze either glycerophosphoinositol or glycerophosphocholine. Unexpectedly, both GDE4 and GDE7 show a lysophospholipase D activity toward lysophosphatidylcholine (lyso-PC). We purified the recombinant GDE4 and GDE7 proteins and show that these enzymes can hydrolyze lyso-PC to produce lysophosphatidic acid (LPA). Further characterization of purified recombinant GDE4 showed that it can also convert lyso-platelet-activating factor (1-O-alkyl-sn-glycero-3-phosphocholine; lyso-PAF) to alkyl-LPA. These data contribute to our current understanding of mammalian GP-PDEs and of their physiological roles via the control of lyso-PC and lyso-PAF metabolism in gastrointestinal epithelial cells and macrophages

Objective: To determine the safety and effectiveness of blood donation in anemic patients, we harvested blood from cardiac patients with baseline hemoglobin levels below 11.0 g/dl.Methods: Subjects were 118 patients who underwent elective cardiac surgery between January 1994 and October 1997. We assigned patients to 1 of 2 groups based on their entry hemoglobin level: an anemic group (hemoglobin < 11.0 g/dl, n = 20) and a nonanemic group (hemoglobin ≧ 11.0 g/dl, n = 98). All patients received subcutaneous administration of recombinant human erythropoietin, and autologous blood was collected once a week for at least 3 weeks before the scheduled surgery date if the hemoglobin level exceeded 10.5 g/dl.Results: No statistically significant differences were seen between the 2 groups in patient profiles or surgical data. The estimated hemoglobin increase did not differ significantly between groups at any time point. The total collected blood volume per patient was greater in the nonanemic group than in the anemic group (1098 ± 224 ml vs. 712 ± 334 ml), but the difference in volume was not statistically significant The percentage of patients who received allogeneic blood did not differ significantly between groups. No side effects were associated with hemoglobin level prior to donation because the incidence of side effects was similar across hemoglobin levels.Conclusions: This study suggests that autologous blood donation reduces the need for allogeneic blood in patients with baseline hemoglobin levels below 11.0 g/dl.

We experienced a case of chronic traumatic aneurysm of the thoracic arota due to a traffic accident. This paper presents the case with a review of the relevant literature in Japan. A 26-years-old man was seen at the hospital because of an abnormal shadow on a chest X-ray film which was incidentally found 7 years after blunt trauma on the chest at the traffic accident. With contrast enhanced CT and angiography of the chest, the patient diagnosed as having a chronic traumatic aneurysm of the thoracic aorta. The patient was asymptomatic, but was operated on because of possible enlargement of the aneurysm and risk of rupture. Operative procedures included left posterolateral thoracotomy and grafting under partial extracorporeal circulation. Postoperative course was uneventful without particular complication. The patient was discharge from the hospital on the 18th hospital day. Chronic traumatic aneurysm of the thoracic aorata is a rare disease. If the disease is suspected from a blunt trauma on the chest, early diagnosis followed by surgical operation is essential.

Concomitant injuries of abdominal and thoracic organs are frequently encountered in an acute phase of traumatic diaphragmatic hernia and strangulation often occurs in latent or obstructive phase. Recently three cases of traumatic diaphragmatic hernia caused by blunt injury in a different phase were successfully operated on a Case 1: A 27-year-old man was admitted to the hospital for gastric obstruction. There was a history of blunt chest and abdominal injury 2 months before admission. He was operated on through the thoracic approach after the reduction of gastric obstruction by naso-gastric tube. The stomach and omentum prolapsed into the left thoracic cavity with adhesions to the diaphragm and lung. Reduction of the prolapsed organs into the abdominal space was followed by the direct closure of the diaphragmatic rupture. Case 2: A 46-year-old woman was admitted 12 hours after injury. The stomach, omentum, colon and spleen protruded through the diaphragmatic rent into the pleural cavity with splenic rupture, mesenteric hematoma and bilateral hemo-pneumothorax. The flail chest due to multiple rib fractures necessitated her to be placed on the ventilator for a week. She was operated on through the thoracoabdominal approach. Splenectomy, reduction of prolapsed organs and direct closure of the ruptured diaphragm were performed. Case 3: A 58-year-old woman was in a latent phase, 3 years after injury. After reduction of the stomach and omentum which had prolapsed into the left thoracic cavity and adhered to the diaphragm, the rupture was repaired directly through the thoracic approach. In these cases, the lacerations run along the course of muscle fibers and were located in and around the centrum tendineum, so the repair of the diaphragm could be done easily through the thoracic approach.

Background . Various blood management strategies can be used to reduce the need for allogeneic blood in cardiac surgery. In anemic patients, however, avoidance of allogeneic blood transfusion is difficult to achieve. This study was performed to assess the safety and effectiveness of preoperative blood collection using recombinant human erythropoietin (rHuEPO) for reducing the exposure to allogeneic blood in anemic patients. Methods . Thirty-two anemic patients undergoing cardiac surgery at our hospital between January 1994 and October 1997 were divided into two groups according to preoperative strategies: 3-week treatment with rHuEPO and blood donation (group 1, n=16) or iron supplementation alone (group 2, n=16). Results . There were no statistically significant differences between the two groups in patients' characteristics and surgical data. The number of reticulocytes was increased at just before surgery in group 1, whereas group 2 showed no significant increase. The estimated hemoglobin increases in group 1 were higher at 7 days and just before surgery. The mean number of required allogeneic blood for patients during surgery was 0.59 ± 1.12 U in group 1 and 5.01 ± 2.63 U in group 2. In 75% of group 1 patients, allogeneic blood transfusion was successfully avoided, whereas all patients in group 2 received allogeneic blood. Conclusions . This study suggests that the combination of rHuEPO administration and autologous blood donation can reduce the need for allogeneic blood in anemic patients.