The correlation between Salter's criteria for avascular necrosis of the femoral head and Kalamchi's prognostic classification following the treatment of developmental dysplasia of the hip.

AIMS: The aim of this study was to evaluate the correlation between Salter's criteria and Kalamchi's classification of avascular necrosis in patients treated for developmental dysphasia of the hip (DDH). PATIENTS AND METHODS: The study involved a retrospective analysis of 123 patients (123 hips) with DDH treated by operative and non-operative reduction before the age of two years, with a minimum follow-up of ten years. Salter's criteria (S1 to S4) were determined from radiographs obtained at one to two years post-reduction, whilst the Kalamchi grade was determined from radiographs obtained at ten or more years of age. Early post-reduction radiographs were also used to evaluate the centre-head distance discrepancy (CHDD) and the occurrence of a dome-shaped deformity of the proximal femoral metaphysis (D-shaped metaphysis). The prognosis was described as good (Kalamchi grade K0 or KI), fair (Kalamchi grade KII) or poor (Kalamchi grade KIII or KIV) for analysis and correlation with the early Salter criteria, CHDD and D-shaped metaphysis. RESULTS: S1 and S2 criteria were predictive of a poor prognosis. The outcome following S3, S4 and S3 + S4 varied; 18 (40%) had a good prognosis, 17 (38%) a fair prognosis and ten (22%) a poor prognosis. A CHDD ≥ 10% and a D-shaped metaphysis were also predictive of a poor prognosis. CONCLUSION: The Salter criteria were predictive of the Kalamchi grade of avascular necrosis in patients with DDH aged ten or more years after reduction of the hip. Cite this article: Bone Joint J 2017;99-B:1115-20.

[Renal cell carcinoma extending into the right atrium; report of a case].

A 62-year-old male was diagnosed through abdominal ultrasonography, with right renal cell carcinoma extending into the inferior vena cava. Surgery was performed because echocardiography revealed the tumor to have reached the right atrium. The portion of the tumor situated in the right atrium was resected under the extracorporeal circulation. Distal part of inferior vena cava was resected with the tumor included. The tumor remaining in the confluence of hepatic veins was removed from the incised end of the inferior vena cava and was detached from the venous wall. Postoperative abdominal echography revealed a small additional tumor mass in hepatic veins. Although this mass was considered to be a remnant of the intravenous tumor, an additional surgical procedure was judged to be impossible. In retrospect, an additional long-axis incision on the inferior vena cava might have enabled us to catch the remnant of the tumor thrombus in the hepatic vein.

[A case report on two stage operation of dissecting aneurysm of DeBakey IIIb type associated with dense pulmonary adhesion].

Successful surgical treatment of chronic dissecting aneurysm (DeBakey IIIb type) in a 50-year-old man was reported. His left lung was tightly adhered to the aneurysm and the chest wall, because he had a previous operation history for pyothorax. This patient showed copious pulmonary bleeding by the pulmonary injury during adhesiotomy. We selected the two stage operation for deducting operation risks, and finished the first operation at the end of adhesiotomy. Some pieces of e-PTFE sheet had been put between lung and thoracic wall, or aneurysm. After a week, waiting the cure of this pulmonary injury, the second operation was performed with a small quantity of pulmonary bleeding. There wasn't fresh pulmonary adhesion because of protection by e-PTFE sheet. The two stage operation was useful in cases associated with dense pulmonary adhesion.

A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle.

Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.

Isolation and characterization of two distinct myo-inositol transporter genes of Saccharomyces cerevisiae.

By the complementation of a yeast mutant defective in myo-inositol transport (Nikawa, J., Nagumo, T., and Yamashita, S. (1982) J. Bacteriol. 150, 441-446), we isolated two myo-inositol transporter genes, ITR1 and ITR2, from a yeast gene library. The ITR1 and ITR2 genes contained long open reading frames capable of encoding 584 and 612 amino acids with calculated relative molecular masses of 63,605 and 67,041, respectively. The sequence similarity between the ITR1 and ITR2 products was extremely high, suggesting that the two genes arose from a common ancestor. Both gene products show significant sequence homology with a superfamily of sugar transporters, including human HepG2 hepatoma/erythrocyte glucose transporter and Escherichia coli xylose transporter. Hydropathy analysis indicated that the ITR1 and ITR2 products are both hydrophobic and contain 12 putative membrane-spanning regions. Thus, yeast myo-inositol transporters could be classified into the sugar transporter superfamily. Gene disruption and tetrad analysis showed that yeast cells contain two separate myoinositol transporters. The ITR1 product was the major transporter and the ITR2 product the minor one in cells grown in minimum medium containing glucose. Northern blot analysis showed that ITR1 mRNA was much more abundant than ITR2 mRNA. The previously isolated myo-inositol transport mutant was determined to be defective in ITR1.

Expression in Escherichia coli of the Saccharomyces cerevisiae CCT gene encoding cholinephosphate cytidylyltransferase.

The coding region of the CCT gene from the yeast Saccharomyces cerevisiae was cloned into the pUC18 expression vector. The plasmid directed the synthesis of an active cholinephosphate cytidylyltransferase in Escherichia coli, confirming that CCT is the structural gene for this enzyme. The enzyme produced in E. coli efficiently utilized cholinephosphate and N,N-dimethylethanolaminephosphate, but N-methylethanolamine-phosphate and ethanolaminephosphate were poor substrates. Consistently, disruption of the CCT locus in the wild-type yeast cells resulted in a drastic decrease in activities with respect to the former two substrates. When activity was expressed in E. coli, over 90% was recovered in the cytosol, whereas most of the activity of yeast cells was associated with membranes, suggesting that yeast cells possess a mechanism that promotes membrane association of cytidylyltransferase.

Primary structure of the yeast choline transport gene and regulation of its expression.

The yeast Saccharomyces cerevisiae possesses a choline transport system encoded by the CTR gene. Incorporated choline is exclusively utilized for the synthesis of phosphatidylcholine. Determination of the complete nucleotide sequence of the CTR gene showed that the deduced primary sequence of the choline transporter comprised 563 amino acid residues with a calculated molecular weight of 62,055. Both the amino- and carboxyl-terminal regions were hydrophilic whereas the rest of the sequence was highly hydrophobic and contained several membrane-spanning regions. There were four potential glycosylation sites in the hydrophilic parts of the sequence. The transporter showed significant sequence similarities to the yeast arginine and histidine transporters. A 2.0-kilobase RNA species was identified as the CTR transcript. Disruption of the CTR locus completely abolished the choline transport activity, indicating that the CTR product is the sole choline transporter in yeast. The regulation of choline transport mRNA was investigated by Northern blot analysis using a CTR probe. The abundance of CTR mRNA significantly decreased on incubation of cells with a combination of choline and myo-inositol. The CTR mRNA level was high in the exponential growth phase but decreased dramatically when cells entered the stationary phase. Similar control had been observed for some enzymes in yeast phospholipid synthesis.

Molecular cloning and characterization of the gene encoding cholinephosphate cytidylyltransferase in Saccharomyces cerevisiae.

1. The structural gene for cholinephosphate cytidylyltransferase (CCT) was isolated from a Saccharomyces cerevisiae genomic library by means of complementation in a mutant of the yeast defective in the enzyme. The cloned DNA restored both the growth and cholinephosphate cytidylyltransferase activity of the mutant. Whereas the enzyme of the mutant was thermolabile, the enzyme produced by the transformant was indistinguishable in heat stability from that produced by the wild type. 2. Strains carrying a multicopy recombinant plasmid overproduced cholinephosphate cytidylyltransferase. The overproduction of the enzyme brought about an increase in the synthesis of CDPcholine in the transformant, but there was no increase in the overall rate of phosphatidylcholine synthesis. 3. The cloned DNA was subcloned into a 2.5-kb DNA fragment. The nucleotide sequence which contained CCT was determined by the dideoxy chain-termination method. The sequence contained an open reading frame capable of encoding a protein of 424 amino acid residues with a calculated relative molecular mass of 49,379.31. Northern blot analysis showed that this DNA segment is transcribed in yeast cells and the length of the transcript is consistent with the putative translation product. 4. Hydropathy analysis according to Kyte and Doolittle indicated that the primary translation product contains extended hydrophilic stretches in its N- and C-terminal regions. 5. The primary translation product contains a region showing local sequence homology with nucleotidyl-transfer enzymes such as DNA polymerase (Escherichia coli), CDPdiacylglycerol pyrophosphatase (E. coli), 3-deoxy-manno-octulosonate cytidylyltransferase (E. coli) and DNA ligase (T4 phage), suggesting that these five enzymes are evolutionarily related. Statistically significant sequence homology was also noted between the human c-fos gene product and the enzyme.

Nucleotide sequence and characterization of the yeast PSS gene encoding phosphatidylserine synthase.

1. A yeast chromosomal DNA which contains the structural gene for phosphatidylserine synthase (PSS) was isolated by genetic complementation from a wild-type yeast genomic library. The PSS gene was subcloned into a 1.1-kb fragment of the yeast DNA on the YEp13 vector. 2. The PSS gene on the multicopy plasmid caused the fourfold over-production of the enzyme and fully restored the phosphatidylserine content of the transformant. The phospholipid composition of the transformant was similar to that of the wild type. 3. Sequence analysis showed that this DNA fragment contains an open reading frame capable of encoding 276 amino acid residues with a calculated relative molecular mass of 30,804. Northern blot analysis of poly(A)-rich RNA of the wild-type yeast indicated that this DNA segment is transcribed into a single mRNA species. 4. The DNA sequence contained two putative transcriptional initiation signals, each followed by the ATG initiator codon. Deletion experiments indicated that the 5'-proximal ATG codon is essential for the synthesis of the functional phosphatidylserine synthase.

Cloning of a gene encoding choline transport in Saccharomyces cerevisiae.

By genetic complementation in a yeast choline transport mutant from a yeast gene library, we isolated plasmids encoding choline transport. The cloned plasmids contained a common 4.0-kilobase DNA fragment and also complemented an ethanolamine transport defect. The cloned sequence present in the yeast genome was possibly unique.