Role of mycorrhizal associations in tree spatial distribution patterns based on size class in an old-growth forest.

An important factor controlling tree species diversity is conspecific density dependence (CDD). Adult trees associated with arbuscular mycorrhiza (AM) and ectomycorrhiza (ECM) can exhibit negative and positive CDD effects on conspecific recruitment, respectively. However, the extent to which these mycorrhizal associations affect spatial distributions of individual trees and their relative abundances within forests through CDD remains uncertain. We analysed changes in spatial correlations between adults and conspecific juveniles at different growth stages of five hardwood species in a 6-ha plot of an old-growth forest using a point pattern analysis. The clump sizes of large individuals were also evaluated using the Iδ index (a measure of individual dispersion) in 24 species. In two AM-associated species, juveniles were distributed at greater distances with increasing size or were always distributed at a distance from adults, resulting in small clumps of adults. In contrast, juveniles of two ECM-associated species were distributed close to adults during early or late growth stage, resulting in large clumps of adults. Juveniles of an ECM-associated species disappeared with increasing size, probably due to shade intolerance. In 24 tree species with large numbers of individuals within a plot, the relative basal area was related to both mycorrhizal type and maximum diameter, suggesting that the relative abundance of a species is largely related to its mycorrhizal associations and maximum plant size. This study strongly demonstrated that mycorrhizal associations play an important role in determining the spatial distribution patterns and community structure of tree species through CDD.

[Drug-eluting stents restenosis 2 months after the procedure and necessitating semi-emergency off-pump coronary artery bypass].

Drug-eluting stents (sirolimus-eluting stent: Cypher stent) have showed a reducing the frequency of in-stent restenosis and a good safety profile. One case involving edge dissection with Cypher stent restenosis for 2 lesions was diagnosed in 2 months after the procedure. This case occurred in a hypertensive 63-year-old woman with complex coronary lesions. The coronary angiography showed uncovered proximal dissection with 90% restenosis in left anterior descending coronary artery to left main trunk and 75% restenosis in right coronary artery. We were able to perform semi-emergency off-pump coronary artery bypass (OPCAB). There is the relationship between coronary dissection and restenosis. Cypher stent delayed dissected arterial healing and promote some inflammation at the lesion. Patients implanted Cypher stent with uncovered coronary dissection need more frequent follow-up.

Bradykinin stimulates the release of tissue plasminogen activator in human coronary circulation: effects of angiotensin-converting enzyme inhibitors.

OBJECTIVES: The goal of this study was to determine: 1) whether bradykinin (BK) directly stimulates tissue plasminogen activator (tPA) secretion in human coronary circulation, and 2) whether angiotensin-converting enzyme (ACE) inhibition favorably alters the fibrinolytic balance regulated by BK. BACKGROUND: Bradykinin is a potent stimulator of tPA secretion in endothelial cells; however, the effect of BK on tPA release in the human coronary circulation has not been studied. METHODS: Fifty-six patients with atypical chest pain were randomly assigned to two groups: 25 patients were treated with the ACE inhibitor enalapril (ACE inhibitor group), and 31 were not treated with ACE inhibitors (non-ACE inhibitor group). Graded doses of BK (0.2, 0.6, 2.0 microg/min), acetylcholine (ACh) (30 microg/min) and papaverine (PA) (12 mg) were administered into the left coronary artery. Coronary blood flow (CBF) was evaluated by Doppler flow velocity measurement. Blood samples were taken from the aorta (Ao) and the coronary sinus (CS). RESULTS: Bradykinin induced similar increases in CBF in both groups. The net tPA release induced by BK was dose-dependently increased in both groups, and the extent of that increase in the ACE inhibitor group was greater than that in the non-ACE inhibitor group. Bradykinin did not alter plasminogen activator inhibitor-1 (PAI-1) levels in the Ao or CS in either group. Neither ACh nor PA altered tPA levels or PAI-1 levels in either group. CONCLUSIONS: Intracoronary infusion of BK stimulates tPA release without causing any change in PAI-1 levels in the human coronary circulation. In addition, this effect of BK is augmented by an ACE inhibitor.

Coronary vasomotor responses to bradykinin and acetylcholine in patients with coronary spastic angina.

It is unclear whether coronary endothelial function is linked to the pathogenesis of coronary spastic angina (CSA), so the present study examined the coronary vasomotor responses to acetylcholine (ACh) and bradykinin (BK) in 23 patients with CSA, 26 patients with CSA+coronary artery disease (CAD), and 21 control patients. Acetylcholine induced vasospasm of the left coronary artery in all of the patients with CSA, but not in any of the control patients. The changes in dilatation of the left coronary artery in response to bradykinin at doses of 0.2, 0.6 and 2.0 microg/min in the CSA group were significantly greater than those in the other 2 groups. The ratio of epicardial coronary vasodilations induced by BK to those induced by nitroglycerin did not differ among any of the groups. Bradykinin caused a similar increase in coronary blood flow in the control group and CSA group, but had less of an effect in the CSA+CAD group. In conclusion, the vasorelaxing effect of BK was preserved not only in epicardial spasm coronary arteries induced by ACh, but also in resistance coronary arteries distal to the spasm arteries in patients with CSA. The coronary vasodilation response induced by BK may not deteriorate until coronary atherosclerosis advances in patients with CSA.

Correction of CAPD catheter displacement using gastric biopsy forceps: the push-pull method.

We corrected malpositioned continuous ambulatory peritoneal dialysis catheters in six patients using a new technique named the "push-pull method". A gastric biopsy forceps was advanced through the catheter to near its tip. After manipulating the tip of the forceps through the abdominal wall, the forceps was opened and pulled out slowly. Repeated insertion and removal of the forceps induced the catheter to return to the pelvic cavity. This push-pull method was successful for Swan neck straight (n=2) and coiled (n=4) catheters in all patients. The time required for the procedure was only 5-10 minutes and there were no complications.

A case of aortitis syndrome and IgA nephropathy: possible role of human leukocyte antigens in both diseases.

A 51-year-old woman, who had both aortitis syndrome (Takayasu arteritis) and IgA nephropathy, presented with hypertension, fever, a high erythrocyte sedimentation rate, high C-reactive protein and serum IgG levels, proteinuria, and renal dysfunction. Renal arteriography showed stenosis and poststenotic dilatation at the origin of the right renal artery, as well as tortuosity of the left renal artery branches and marked atrophy of the left kidney. Renal biopsy showed IgA nephropathy with deposits of IgA, C3, and fibrinogen in the glomeruli and arteriolosclerosis. The present patient had human leukocyte antigen (HLA)-B 52, which is reported to be related to the aortitis syndrome, as well as HLA-DR 4, which is possibly related to IgA nephropathy, suggesting that HLA status may be involved in the pathogenesis of both diseases.

Dose escalation induces tolerance to side-effects of erythropoietin in a patient with dialysis anaemia: case report.

A 51-year-old woman began haemodialysis for chronic renal failure in February 1981. Symptomatic anaemia required treatment with recombinant human erythropoietin (rHuEPO) in February 1990 (3000 IU, twice weekly, intravenously). She developed influenza-like symptoms and treatment was withdrawn. In June 1994 rHuEPO was resumed at a very low dose of 100 IU subcutaneously three times weekly, and was increased gradually to 500 IU, without inducing any side-effects. At this dose the haematocrit was maintained at 22.0-25.0% and the symptoms of anaemia improved. In patients like ours, with influenza-like symptoms caused by rHuEPO therapy, dose escalation starting from an ultra-low dose may be effective in avoiding side-effects.

[Influence of sevoflurane and isoflurane anesthesia on renal function in elderly patients].

We examined the influence of sevoflurane and isoflurane anesthesia on renal function in elderly patient who underwent gastrectomy. Plasma inorganic fluoride level was significantly higher in sevoflurane group compared with isoflurane group from 3 hours after the beginning of anesthesia to the 3rd operative day. In contrast, parameters such as urinary beta 2 microglobulin, urinary N-acetyl-beta-D-glucosaminidase, and urinary gamma-GTP activities increased in both groups, but the increase was not significant. Serum BUN and creatinine levels were within normal limits. These results suggest that elderly patients without renal dysfunction appear unlikely to have any significant problem after prolonged sevoflurane anesthesia.

[Relationship between apneic episodes and destruction of temporomandibular joints in patients with rheumatoid arthritis].

There have been only a few investigational reports of sleep apnea syndrome (SAS) in patients with rheumatoid arthritis (RA), although it may not be a rare condition and may be life-threatening occasionally. The factor precipitating SAS in such patients is thought to be destruction of the temporomandibular joints (TMJs) from RA processes. To assess the relationship of the degree of destruction of the TMJs to the frequency of apnea, we examined them in 10 RA patients who complained of snoring. Those patients were classified as classical RA according to the criteria of American Rheumatism Association. They consisted of 3 males and 7 females with a mean age of 57.8 + 11.0 years and a mean disease duration of 15.9 +/- 9.4 years. In order to numerically evaluate the degree of destruction of the mandibular rami, we quoted a method from the literature (Redlund-Johnell I, Scand J Rheumatol 16:355, 1987) and measured the vertical distance (= ramal height) from the mandibular angle to the palato-occipital line on the lateral view film of the cervical spine in each patient. The mean values of ramal height (RH) of the normal material (we studied in Japanese) are 46.0 mm in males and 38.3 mm in females. There were 8 cases of SAS out of the 10 RA patients studied. Their mean total apneic episode (TAE) was 289.9 mm with a range of 0-611. The mean ratio (%) of RH to mean value of the normal material (%RH) was 68.8 +/- 22.2% for all. There was a significant statistic correlation between TAE and %RH (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistochemical studies of extracellular matrix components and integrins in IgA nephropathy.

Localization of adhesive glycoproteins as the extracellular matrix and their cell surface receptors (integrins) were studied in an attempt to clarify their roles in the progression and aggravation of IgA nephropathy. The relationship between their localization and factors associated with clinical progression was then investigated in 65 patients with IgA nephropathy. The indirect immunoperoxidase method was used to study the distribution of fibronectin (FN), vitronectin (VN), fibronectin receptor (FNR) and vitronectin receptor (VNR). In all cases, FN was present in the glomeruli, mainly confined to the mesangial region, and in some cases, it was observed along the glomerular capillary loops. An expanded mesangial region accompanied higher FN distribution. FNR was present in the mesangial region and glomerular capillary loops, and was higher in the expanded mesangial region. VN was positive in 51 of 65 cases. In all cases, VNR was present in the mesangium and glomerular capillary loops, and its distribution was more predominant in and along the capillary loops than in the mesangial region. The expanded mesangium accompanied higher VNR distribution. There was a significant correlation in distribution between all factors with the exception of VN and FNR. FN, FNR and VNR increased significantly as a degree of histological damage. However, VN was not significantly associated with the degree of histological damage in positive and negative groups. The distribution of FN, FNR and VNR was associated with clinical aggravation factors although the distribution of VN was not. In conclusion, the distribution and functional alteration of FN and integrins in the glomeruli appear to be involved in the progression and exacerbation of IgA nephropathy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Concentration of imipenem/cilastatin sodium in bone marrow blood following intravenous drip infusion].

A solution of 0.5 g of imipenem (MK-0787) and 0.5 g of cilastatin sodium (MK-0791) in 100 ml of saline was administered to adult patients before the surgery by intravenous drip infusion during 30 minutes. Fifty samples of bone marrow blood were obtained from 26 clinical cases. After centrifugation, the supernatant was mixed with the same amount of a solution of stabilizer then stored at -80 degrees C. The peripheral blood was obtained at the same time as bone marrow blood was sampled and serum was served as control. The concentration of MK-0787 in bone marrow blood at 35 minutes after the start of the infusion was 50 micrograms/ml in 1 case, and decreased to 3.8 micrograms/ml at 260 minutes. The half-life was 1.62 hours. When the concentration of MK-0787 in bone marrow blood was compared to that in serum, the former was higher than the latter in 26 of the 50 samples (52%). In remained 24 samples, the concentration of MK-0787 in bone marrow blood showed to be lower than that in serum (48% of 50 samples). The half-life of MK-0791 in bone marrow blood was 1.10 hours and the level of the drug in bone marrow blood was similarly higher than that in serum in 18 of 40 samples (45%). In other 22 samples, the concentration of MK-0791 in bone marrow blood was lower than that in serum (55%). It was also found that the concentration of MK-0787 in bone marrow blood decreases with time along a similar curve of decrease observed in serum. This agent appears useful for the treatment of bone and joint infections and also for prophylaxis for major surgeries of skeletal tissues.

Observation of "tear-drop" fracture-dislocation of the cervical spine by computerized tomography.

Five cases of "tear-drop" fracture-dislocation of the cervical spine was examined radiologically. Examination by CT scan showed a transverse fracture line in the compressed vertebral body in all cases. In three of five cases, a mid-sagittal fracture line was accompanied by this transverse fracture. Comparing these two types of fracture with neurological complications, severe complications were found among the cases having both fracture lines. On the other hand, the conventional radiographs could not show the relationship between the degree of narrowing of the spinal canal and the severity of complication.

Extensive spinal epidural hemorrhage associated with von Willebrand's disease--a case report.

We have experienced a case of spontaneous spinal epidural hemorrhage associated with von Willebrand's disease. The patient was repeatedly attacked by bleeding of the urinary tract, intramuscular hemorrhage of the right thigh in spite of the administration of AHF. She had a complication of pneumonia and died on the 94th day of hospitalization. The autopsy revealed extensive spinal epidural hemorrhage from the lower part of the first cervical to the 11th thoracic vertebrae. Because of its rarity in previous literature, this case is presented.

Supraclavicular brachial plexus block using a nerve stimulator and an insulated needle.

A technique employing a nerve stimulator and an insulated needle was used for supraclavicular brachial plexus block in 71 patients using 0.5% plain bupivacaine 15-20 ml. The mean minimal stimulating current to produce paraesthesia was 0.09 mA. The plexus was identified at a mean depth of 27 mm below the skin. The block was successful in 98% of patients when the stimulation was felt in the index, middle or ring finger, but was often incomplete when felt in the thumb or little finger.