Differentiation of multiple visceral artery aneurysm rupture from major bleeding after coronary artery bypass grafting.

BACKGROUND: Visceral artery aneurysm is a very rare disease, but it is clinically important because of the high risk of rupture involved. These ruptures must be differentiated from those that occur during hospitalization after extra-abdominal surgery. METHODS: During hospitalization after off-pump coronary artery bypass grafting, a 77-year-old woman developed hypovolemic symptoms and had decreased hemoglobin. There was no obvious bleeding, but while screening for possible complications after cardiac surgery, abdominal computed tomographic angiography showed multiple visceral artery aneurysms of the gastroduodenal and pancreaticoduodenal arteries along with hemoperitoneum. RESULTS: The patient underwent coil embolization of the visceral artery aneurysm and was discharged without any complications. CONCLUSIONS: In patients with coronary artery disease with risk factors for atherosclerosis, if anemia occurs without apparent bleeding after surgery, visceral artery aneurysm should be considered as a differential diagnosis.

Acute biological mitral valve thrombosis after the left atrial venting in a patient with a venoarterial extracorporeal membrane oxygenator.

BACKGROUND: Left atrial venting through atrial septotomy in patients with decreased left ventricular (LV) contractility after venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a simple and effective method for treating LV decompression. MATERIALS & METHODS: We report a case of prosthetic mitral valve thrombosis after left atrial venting in a patient with VA-ECMO. RESULTS: In patients undergoing mitral valve replacement, left atrial venting reduces the flow through the mitral valve and forms a prosthetic thrombosis. DISCUSSION: Therefore, excessive left atrial venting should be avoided. Other venting methods that can maintain the flow through the mitral valve should be considered after mitral valve replacement.

Increased expression of bitter taste receptors in human allergic nasal mucosa and their contribution to the shrinkage of human nasal mucosa.

OBJECTIVE: Bitter taste receptors (TAS2Rs) are expressed in the extraoral tissues, where they possess various physiological functions. This study is to characterize TAS2Rs expression in normal and allergic nasal mucosa and analyse nasal symptom after challenge with bitter tastes to evaluate their pathophysiological function in normal and allergic nasal mucosa. METHODS: The expression levels of TAS2Rs (TAS2R4, 5, 7, 10, 14, 39, and 43) in nasal mucosa were investigated by real-time PCR, Western blot, and immunohistochemistry. The expression levels of TAS2Rs and Ca(2+) imaging in cultured epithelial cells were measured after stimulation with type 2 cytokines (IL-4, IL-5, and IL-13) or bitter tastes. Nasal symptoms in control subjects and allergic rhinitis patients using visual analogue score and acoustic rhinometry were evaluated before and after stimulation with bitter tastes. Vascular diameter of rat nasal septum was measured before and after treatment with bitter tastes. RESULTS: TAS2Rs tested here were expressed in nasal mucosa where they were commonly distributed in superficial epithelium, submucosal glands, and endothelium. Their expression levels are increased in allergic nasal mucosa and up-regulated in cultured epithelial cells simulated with type 2 cytokines. After treatment with bitter tastes, intracellular Ca(2+) signalling was increased in cultured epithelial cells, and vascular constriction was found in rat nasal septum. Increased nasal patency was observed in human nasal mucosa without pain or sneezing. CONCLUSION AND CLINICAL RELEVANCE: TAS2Rs are constitutively expressed in human nasal mucosa and their expression levels are increased in allergic nasal mucosa, where they could potentially contribute to shrinkage of normal and allergic nasal mucosa.

Group-specific regional white matter abnormality revealed in diffusion tensor imaging of medial temporal lobe epilepsy without hippocampal sclerosis.

PURPOSE: In comparison to temporal lobe epilepsy (TLE) patients with hippocampal sclerosis (TLE-HS), TLE patients without HS (TLE-NH) have a similar clinical course but may result in worse surgical outcome. We investigated whether the clinical features related to the lack of HS in TLE patients (TLE-NH) can be explained by water diffusion abnormalities throughout diffusion tensor imaging (DTI) by voxel-based analysis. METHODS: Nineteen patients with TLE-HS (left/right TLE 12:7), 18 patients with TLE-NH (left/right TLE 10:8), and 20 controls were included in the study. By statistical parametric mapping (SPM2), the diffusion properties specific to disease characteristics (TLE-HS vs. TLE-NH) were analyzed. RESULTS: In TLE-HS, we found the areas of increased mean diffusivity (MD) in their ipsilateral temporal and extratemporal areas including the hippocampus, parahippocampal, and frontoparietal regions. Left TLE-HS showed a characteristic MD increase in the ipsilateral posterior cingulum, isthmus of corpus callosum, and contralateral occipital and temporal regions, which was not observed in right TLE-HS group. In left TLE-NH, two regions of increased MD were observed in the ipsilateral posterior fornix (within fusiform gyrus) and posterior cingulum. Right TLE-NH did not show any increased MD. DISCUSSION: In left TLE-NH, we could find the water diffusion change along the posterior cingulum, which was quite different from the extensive abnormality from TLE-HS. In addition, there was a lesion-side-specific distribution (left predominant) of pathology in mesial TLE. This provides a possibility that TLE-NH is a heterogeneous or entity different from TLE-HS.

Suppressed cytokine and immunoglobulin secretions by murine splenic lymphocytes infected in vitro with Toxoplasma gondii tachyzoites.

Mechanisms of host immunosuppression after infection with Toxoplasma gondii are unclear. This study was performed to observe cytokine and immunoglobulin secretions by murine splenic lymphocytes infected in vitro with live, nonreplicating (irradiated) RH tachyzoites on stimulation with concanavalin A (Con A) or lipopolysaccharide (LPS). For lymphocyte cultivation, 3 groups were prepared: coculture with live nonirradiated tachyzoites separated by a transwell (group T), live irradiated tachyzoites without a transwell (group R), and no tachyzoites (group C). Compared with group T, groups R and C, on stimulation with Con A, revealed significantly (P < 0.05) lower levels of interleukin-2 (IL-2) and IFN-gamma, but not IL-10. The levels of IgG1, IgG2a, IgG2b, IgG3, IgA, and IgM were also significantly (P < 0.05) lower in groups R and C than in group T after stimulation with LPS. The results suggest that intracellular infection of murine splenic lymphocytes with T. gondii tachyzoites could impair their capacity to produce cytokine and immunoglobulin secretions.

Expression of differentiation markers during fetal skin development in humans: immunohistochemical studies on the precursor proteins forming the cornified cell envelope.

The cornified cell envelope is formed during the terminal differentiation of epidermis through cross-linking of specific proteins by transglutaminases. The specific arrangement of individual protein in the cornified cell envelope and participation of individual protein in the cornified cell envelope at different regions of skin, i.e., palm, foreskin, lips, etc. are not clearly understood. In order to understand the pattern and expression schedule of each individual precursor protein during the differentiation and formation of cornified cell envelope, the expression of precursor proteins in developing human fetal skins from the first to the third trimester were examined by immunohistochemical studies. Involucrin was found in the periderm and intermediate layer from 14 wk estimated gestational age, while loricrin and small proline-rich protein 1 were found in the periderm from 16 wk estimated gestational age. Filaggrin and trichohyalin that are absent in the adult cornified cell envelope were found in the granular and horny layers from 24 wk estimated gestational age. The precursor proteins except trichohyalin did not change their patterns after the onset of initial expression during development. Trichohyalin was transiently expressed in the granular and horny layers of the epidermis from 24 wk estimated gestational age with peak expression at 27 wk estimated gestational age, but was not detected in adult skin. In hair follicles, trichohyalin expression was stable without change from 20 wk estimated gestational age. These findings suggest that fetal skin may have different sets of barriers from the second trimester; the immature cornified cell envelope is formed in the early second trimester and the mature cornified cell envelope is formed in the late second or early third trimester when filaggrin and trichohyalin appear.

Growth and development of Gymnophalloides seoi in immunocompetent and immunosuppressed C3H/HeN mice.

The growth and development of Gymnophalloides seoi were studied in C3H/HeN mice and effects of immunosuppression of the host on the worm development were observed. Two hundred metacercariae of G. seoi were orally administered to each mouse, and worms were recovered on days 1, 3, 5, 7, 14 and 21 post-infection (PI). The worm recovery rate was significantly higher in immunosuppressed (ImSP) mice than in immunocompetent (ImCT) mice except on days 1 and 3 PI. The worms attained sexual maturity by day 3 PI with eggs in the uterus, and worm dimensions and the number of uterine eggs continuously increased until day 14 PI in ImSP mice. Worms recovered from ImSP mice were significantly larger in size than those from ImCT mice on days 1 and 3 PI, and the number of uterine eggs was significantly larger in ImSP mice on days 5 and 7 PI. Genital organs such as the ovary, testes, and vitellaria, that were already developed in the metacercarial stage, grew a little in size until day 14 PI. The results show that the C3H/HeN mouse is, though not excellent, a suitable laboratory host for G. seoi.

Toxoplasma gondii antibody titers in sera of children admitted to the Seoul National University Children's Hospital.

A total of 542 children under 10 years of age, admitted to the Seoul National University Children's Hospital, was examined for antibody titers of Toxoplasma gondii using indirect latex agglutination (ILA) test. Among them, 7.7% showed positive titers higher than 1:32, without significant difference between males (7.3%) and females (8.5%). The seropositive rate increased with age although the statistical significance was negligible (0.05 < P < 0.1). By residential areas, the prevalence appeared higher among children from southern provinces (Kyongsang-do and Cholla do) than those from other areas, but the statistical significance was also very low (0.05 < P < 0.1). When the seropositive cases were analyzed by coincidental diseases, the prevalence was significantly higher in patients with congenital diseases than in patients with non-congenital diseases (P < 0.05). The results showed that the seropositive rate of toxoplasmosis in children examined was not high compared with other endemic countries. Some correlations are suggested between toxoplasmosis and congenital anomalies in Korea.

Activity of human papillomavirus type 16 P97 promoter in immortal and tumorigenic human oral keratinocytes.

We previously immortalized normal human oral keratinocytes (NHOK) by transfection with cloned human papillomavirus type 16 (HPV-16) genome and converted these immortalized cells to tumorigenic cells with chemical carcinogens. Since the tumorigenic cells expressed higher level of HPV-16 E6/E7 transcripts, we predicted that enhanced E6/E7 expression was induced by mutations at the long control region (LCR) of the viral genome integrated into cellular chromosome. To test this possibility, we sequenced the entire HPV-16 LCR from immortalized and tumorigenic cells, but no difference in the sequences in all of the tested cells was observed. However, it is possible that such differences in the expression of E6/E7 could have originated from different activities of cellular transcription factors in the different cells. To examine this prospect, we subcloned entire LCR into a reporter gene and determined the promoter activity of LCR in immortalized and tumorigenic cells. We found that the LCR promoter activity was significantly higher in tumorigenic cells when comparing to immortalized cells. We also observed that at least 477 nucleotides upstream of E6 open reading frame are needed for the maximum LCR promoter activity in tumorigenic cells.

Intestinal mastocytosis and goblet cell hyperplasia in BALB/c and C3H mice infected with Neodiplostomum seoulense.

Mucosal mast cell (MMC) and goblet cell (GC) responses were observed in the small intestine of two strains of mice (BALB/c and C3H) infected with Neodiplostamum seoulense, and their roles in the host defense and worm expulsion were studied. From day 3 to 28 post-infection (PI) with 200 metacercariae, the worm recovery rate from BALB/c mice was consistently and remarkably higher than that from C3H mice. In the duodenum of both strains of mice, the main habitat of the flukes, mastocytosis was pronounced on day 7 PI but quickly diminished thereafter. Similar kinetics were observed in the jejunum and ileum, although the extent of mastocytosis was lesser in the ileum than other two areas. These MMC kinetics were not different between the two strains of mice. Moreover, the extent of mastocytosis was stronger in BALB/c mice than in C3H mice. GC hyperplasia was remarkable in the duodenum of BALB/c mice throughout the course of infection except day 14 PI, whereas it was recognizable only in the jejunum and ileum of C3H mice on day 7 PI. Mucin activation was evidently demonstrated in both strains of mice throughout the course of infection, but more marked in BALB/c than in C3H mice. The results strongly suggest that mastocytosis and GC hyperplasia are local immune responses against N. seoulense, however, they play a minor role in the host defense and worm expulsion.

Conversion of normal human oral keratinocytes to tumorigenic cells is associated with the acquisition of resistance to TGF-beta.

Normal human epithelial cells cannot proliferate and undergo apoptosis in the presence of transforming growth factor-beta (TGF-beta) in vitro, but many human epidermoid cancer cells are resistant to TGF-beta. Resistance to TGF-beta may thus, in part, be responsible for uncontrolled proliferation of cancer cells. Though detailed mechanisms for the resistance of cancer cells to TGF-beta remain unknown, resistance may be due to decreased expression of TGF-beta receptors from cancer cells. To investigate this possibility, we determined the expression of TGF-beta and type II TGF-beta receptor in primary normal human oral keratinocytes (NHOK), human papillomavirus-immortalized human oral keratinocytes (HOK-16B) and two tumor cell lines derived from HOK-16B (CTHOK-16B-BaP and CTHOK-16B-DMBA). Our results show that (1) the cellular and secretory TGF-beta levels in immortalized and tumor cells were notably lower than in NHOK and (2) the level of type II TGF-beta receptor of the tested cells was similar to each other. Taken together, the conversion of NHOK to tumorigenic cells may, in part, be due to the acquisition of NHOK resistance to TGF-beta through underexpression of this cytokine.

Pathogenicity and lethality of a minute intestinal fluke, Neodiplostomum seoulense, to various strains of mice.

Pathogenicity and lethality of Neodiplostomum seoulense to various strains of mice (mast cell-deficient W/Wv, their normal littermate +/+, C57BL/6, BALB/cA, C3H/HeJ), and a hybrid (BALB/cA x C3H/HeJ)F1 were investigated. When the mice were infected orally each with 200 metacercariae, their abdomen became distended, and all mice died by day 23 postinfection (PI) except BALB/cA, which were severely weakened but recovered after 28 days. Even a smaller infection dose of 25 metacercariae was highly lethal to C3H/HeJ mice. Despite treatment with praziquantel (3 mg/mouse) on day 10 PI, 80% of C57BL/ 6 mice did not recover and died. After day 14 PI, the whole intestine of C57BL/6 mice was contracted and significantly shortened in length, and charcoal meal transit was significantly faster compared with uninfected controls. After incubation in papaverine, the contracted intestines of C3H/HeJ mice did not relax, suggesting that the change is irreversible. In conclusion, N. seoulense has the potential to kill most strains of mice by causing irreversible damage to their intestine. The effects of mucosal mast cells on the survival rate of mice were negligible, because both W/Wv and +/+ mice died around day 20 PI.

Experimental infection of murine splenic lymphocytes and granulocytes with Toxoplasma gondii RH tachyzoites.

Toxoplasma gondii, an intracellular protozoan infecting many kinds of eukaryotic cells, has been used to experimentally infect macrophages, epithelial cells, fibroblasts, and various cancer cells, but rarely T and B lymphocytes or granulocytes. The present study was performed to determine the susceptibility of murine (BALB/c or CBA) splenic T and B lymphocytes, and granulocytes to infection with T. gondii RH tachyzoites. The ultrastructure of the infected host cells was observed by TEM, and the degree of intracellular parasite proliferation was quantified using 3H-uracil uptake assay. At 24 hrs post-culture, the host cell cytoplasm was found to contain 1 or 2, or a maximum of 7-8 tachyzoites. Infected T lymphocytes demonstrated a peripherally displaced nucleus, a parasitophorous vacuole enveloping the parasite, and an increased number of mitochondria. In B lymphocytes infected with tachyzoites, RER was not well developed compared to uninfected B lymphocytes. Uninfected granulocytes contained many electron-dense granules, but T. gondii-infected granulocytes demonstrated a decreased number of granules. Based on the 3H-uracil uptake assay, the susceptibility of T and B lymphocytes, and granulocytes, to infection with T. gondii tachyzoites was fairly high irrespective of cell type and strain of mouse. This strongly suggests deterioration in the functioning of infected host immune cells.

In vitro cultivation of Gymnophalloides seoi metacercariae (Digenea:Gymnophallidae).

Gymnophalloides seoi is a human intestinal trematode prevalent on southwestern islands in Korea. In the present study, we investigated whether G. seoi metacercariae can grow and develop into adults by in vitro cultivation. The metacercariae were obtained from naturally infected oysters, and cultured in vitro for 5 days under three conditions; 37 degrees C/5% CO2, 41 degrees C/8% CO2, or 41 degrees C/5% CO2, in NCTC 109 complete media containing 20% FBS and 1% antibiotics-antimycotics. The degree of worm growth and development was compared with that grown in vivo of C3H mice. The length of the worms cultivated in vitro was 200-300 microns not significantly different from metacercariae, whereas the length of the worms recovered from C3H mice was significantly larger, 300-400 microns. The worms produced eggs when grown in C3H mice or cultured in vitro for 2 days under 41 degrees C/8% CO2 or 41 degrees C/5% CO2, but not when cultured under 37 degrees C/5% CO2. Among the in vitro conditions, 41 degrees C/5% CO2 was best for egg production, although the number of eggs was about half of worms obtained from C3H mice. In conclusion, in vitro cultivation of G. seoi metacercariae into egg-producing adults was partially successful under culture conditions of 41 degrees C/5% CO2 or 41 degrees C/8% CO2.

Effects of gamma-irradiation on the survival and development of Metagonimus yokogawai metacercariae in rats.

To evaluate the feasibility of irradiation as a control measure for metagonimiasis, the metacercariae of Metagonimus yokogawai were irradiated with gamma ray, either after isolation from the sweetfish (Plecoglossus altivelis) or in situ of the fish, and their survival and development in rats were observed at 7 days post-infection. The radiation dose varied from 5 to 100 Gy for the metacercaria-irradiation group and from 5 to 500 Gy for fish-irradiation group. The results showed that the worm recovery rate from the irradiation groups decreased as the radiation dose was increased. Higher doses of radiation were required for the fish-irradiation group to obtain the same results as the metacercaria-irradiation group. The LD50 of the metacercaria-irradiation group was 4.5 Gy, whereas that of the fish-irradiation group 6.2 Gy. A few number of worms which survived until 7 days in rats were severely retarded especially in the growth of their reproductive organs, i.e., complete or partial failure in the development of testes and formation of uterine eggs. The present study revealed that irradiation of sweetfish by 200 Gy is effective to control infectivity as well as development of M. yokogawai metacercaria in rats.

Effects of gamma-irradiation on intracellular proliferation of Toxoplasma gondii RH tachyzoites.

A quantitative assay was performed on the effects of gamma-irradiation (30-300 Gy) on intracellular proliferation of Toxoplasma gondii RH tachyzoites in human leukemic HL-60 cells and murine peritoneal macrophages by means of 3H-uracil uptake assay. Infected non-irradiation group (NI) and uninfected group (incubating only host cells) were prepared. The 3H-uracil uptake by tachyzoites of NI group 12-24 hrs after infection was 2,190-4,787 counts per minute for macrophages and 2,967-8,254 for HL-60 cells, whereas the irradiated tachyzoites revealed only 381-703 (100 Gy) and 218-408 (300 Gy) for macrophages, and 1,911-2,618 (30 Gy), 1,253-1,384 (70 Gy), 1,013-1,090 (100 Gy), and 483-588 (300 Gy) for HL-60 cells. The proliferation inhibition rate was similar in macrophages and HL-60 cells, for example, 89-94% and 80-94% respectively by 300 Gy, 12-24 hrs after infection. It is concluded that RH tachyzoites of T. gondii are severely affected by gamma-irradiation in their capability of intracellular proliferation.

Infestation rate of lice in patients in a mental hospital, Seoul, Korea.

We examined the infestation rate of head and/or body lice in patients in a mental hospital, Seoul, Korea on June 27-28, 1988. Of 438 women, 146 (33.3%) were positive with nits or worms of louse. Of 143 men, 22 (15.4%) were positive with those of louse. Regular control programs were necessary to this hospital.

The first discovery of an endemic focus of Heterophyes nocens (Heterophyidae) infection in Korea.

A highly endemic focus of human infection with Heterophyes nocens (Heterophyidae) was discovered from a small coastal village of Shinan-gun, Chollanam-do, for the first time in Korea. Fecal examinations by cellophane thick smear and formalin-ether sedimentation techniques revealed 42.9% heterophyid egg positive rate out of 98 inhabitants examined. It was difficult to confirm the species of heterophyids only by eggs. In order to collect the adult flukes, the egg positive cases were treated with 10 mg/kg single dose of praziquantel and purged with magnesium sulfate, and the adult worms were collected from the diarrheic stools. From each of 18 cooperative patients 1 to 1,124 (total 4,730) H. nocens worms were recovered, together with a few to large numbers of heterophyids (Pygidiopsis summa, Stictodora fuscatum) and/or gymnophallids (Gymnophalloides seoi). It is speculated that H. nocens might be widely distributed along the southwestern coastal areas where the brackish water fish such as the mullets or gobies are popularly eaten raw.