The use of a thin abdominal flap in degloving finger injuries.

Three multiple-finger degloving injuries were successfully resurfaced with thin abdominal flaps. This method offers immediate total wound coverage in multiple-finger degloving injuries.

Germline mutations of the MEN1 gene in Japanese kindred with multiple endocrine neoplasia type 1.

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant familial cancer syndrome. The responsible gene MEN1 has recently been isolated, and its germline mutations have been identified in affected individuals in the United States, Canada and Europe. We screened for MEN1 mutations by direct nucleotide sequencing of all protein-coding regions, and identified five distinct germline mutations in five among six Japanese kindreds with familial MEN1 or familial hyperparathyroidism. The mutations were dispersed across the gene. These findings suggest that, because of the absence of an obvious founder effect, the entire MEN1 gene region should be examined for germline mutations in the probands of MEN1 and related syndromes in Japanese families.

Safety and feasibility of continuous monitoring of coronary flow velocity in acute myocardial infarction by Doppler guide wire.

We investigated the safety and limitations of the Doppler guide wire for continuous monitoring of coronary flow velocity outside the catheterization laboratory in 17 patients with acute myocardial infarction. After direct angioplasty, patients were taken to the coronary care unit with the Doppler guide wire positioned within the artery. Flow velocity was continuously monitored. Heparin was titrated to an active clotting time > 200 seconds. Clinical outcome and angiographic analyses were evaluated. Flow velocity monitoring was conducted with an 88.2% success rate and lasted for 16 +/- 5 hours. Monitoring failed in 2 of the 4 right coronary artery cases. Small amounts of thrombus were seen to adhere to the Doppler guide wire at the end of monitoring. No complications were related to the procedure. No deterioration of angiographic findings was observed. This preliminary study confirmed the safety of the Doppler guide wire for continuous monitoring of coronary flow in patients with acute myocardial infarction.

Distal coronary flow velocity immediately after direct angioplasty for acute myocardial infarction.

To evaluate coronary flow dynamics after direct angioplasty and to define the determinants of flow-velocity variables in the infarct artery, we measured coronary flow velocity in 36 infarct arteries and 64 normal coronary arteries by using a Doppler guide wire. Flow-velocity variables in the infarct arteries did not return to normal even after successful direct angioplasty, and phasic coronary flow in infarct arteries varied considerably. Normal phasic flow was calculated as the ratio of diastolic to systolic flow ratio (DSVR) of greater than or equal to mean DSVR - 1 SD in normal coronary arteries. Infarct-related arteries were divided into two groups: normal DSVR (n = 28) and low DSVR (n = 8). Reduced diastolic peak velocity with a relative preservation of systolic velocity contributed to a low DSVR flow. Angiographic slow flow and late recanalization were significantly related to low DSVR flow. Thus the extent of disturbed microcirculation can be evaluated by assessing phasic flow after direct angioplasty for acute infarction.

Do superoxide radicals in blood indicate anastomotic patency after microvascular tissue reperfusion?

Superoxide radicals were measured in the blood of six patients who underwent vascular reconstruction after ischemic injury in an attempt to predict prognosis following surgery. Three free-tissue transfers (two free latissimus dorsi flaps, one free vascularized fibular osteocutaneous graft) were performed on patients with skin or bone defects associated with open tibial fractures. Vascular reconstructions were performed on two patients with popliteal vascular injuries, in one case with an open femoral fracture and in another with an open knee dislocation. A third vascular reconstruction was performed on a patient with a subclavian artery injury associated with a clavicular fracture. Superoxide levels in the blood were quantified by a chemiluminescence method using a derivative of luciferin. Blood was obtained prior to reperfusion and periodically to 72 hr postoperatively. In patients who underwent successful reconstructions, superoxide levels increased after reperfusion. Vascular insufficiency was associated with acute drops in superoxide concentrations. Superoxide levels are a promising clinical marker which can predict insufficiency during reperfusion following tissue ischemia.

Elastic recoil following percutaneous transluminal coronary angioplasty and Palmaz-Schatz stent implantation.

The post-procedural elastic recoil in 133 lesions treated with the Palmaz-Schatz stent was compared to 133 matched lesions treated with balloon angioplasty to determine the role of prevention of elastic recoil in the creation of a larger initial luminal diameter. Elastic recoil was defined as the difference between the maximal diameter of the inflated balloon and the minimal luminal diameter of the dilated segment immediately after the procedure and was evaluated by quantitative coronary angiography. Overdilatation was defined as a dilatation induced by a balloon with a maximal diameter larger than the pre-procedure reference diameter. The percent diameter stenosis was reduced from 73% to 31% in the balloon angioplasty group and from 72% to -4% in the stent group (31% vs. -4%, p < 0.01). Elastic recoil was significantly larger in the balloon angioplasty group than in the stent group (0.94 +/- 0.29 mm vs. 0.09 +/- 0.09 mm, p < 0.01). Overdilatation and lesion morphology had no significant effects on elastic recoil in the stent group. In the balloon angioplasty group, overdilatation, noncalcified lesions and eccentric lesions were associated with increased elastic recoil. These results indicated that the larger post-procedural luminal diameter associated with the Palmaz-Schatz stent was primarily the result of prevention of elastic recoil, which was not influenced by the degree of overdilatation or lesion morphology.

Mixed cultures comprising syngeneic and allogeneic mouse keratinocytes as a graftable skin substitute.

Using inbred mouse strains C3H/He and BALB/c and an anti-class I MHC monoclonal antibody, we examined the graftability of mixed cultures composed of syngeneic and allogeneic mouse keratinocytes. Keratinocytes from neonatal C3H/He (syngeneic donor) and BALB/c (allogeneic donor) mice were cultured for 7 days, both individually and at the inoculum ratio of 1:1, 1:3, or 1:15. The resulting sheets of keratinocytes were implanted subcutaneously into adult C3H/He mice and morphological evaluation was made on the 4th, 7th, and 14th days after grafting. The control cultures of 100% allogeneic keratinocytes were rejected, whereas epidermal reconstruction without typical signs of rejection took place in all grafts derived from the mixed cultures, including the 1:15 cultures. However, immunofluorescence staining showed that, within the grafts, the allogeneic keratinocytes were gradually replaced by syngeneic cells. Thus, these results suggested that graftable skin substitutes may be produced by co-culturing a small amount of autologous keratinocytes with allogeneic keratinocytes, which are readily available.

Newly established cell lines from Drosophila larval CNS express neural specific characteristics.

From the central nervous system of Drosophila melanogaster 3rd instar larvae, eight continuous cell lines have been established (named ML-DmBG1 to 8). Using ML-DmBG2, single colony isolation was carried out and six colonial clones were obtained. All reacted to the antibody to horseradish peroxidase, which is a neuronal marker in insects. Acetylcholine, a known neurotransmitter in Drosophila, was detected in three of the colonial clones by high performance liquid chromatography. Therefore, it is concluded that the established colonial clones are neural cells originating in the larval central nervous system. Among them, some variation was observed with respect to morphology, acetylcholine content, and reactivity to anti-HRP. The variation may reflect the heterogeneity of cells composing the central nervous system.

Myocardial reperfusion can be predicted by myoglobin/creatine kinase ratio of a single blood sample obtained at the time of admission.

To evaluate noninvasive markers for determining the reperfusion status without coronary angiography (CAG) or serial blood sampling in patients with acute myocardial infarction (AMI), two markers were examined: (1) serum myoglobin (Mb) level and (2) serum myoglobin/creatine kinase ratio (Mb/CK). Before emergency CAG a blood sample was drawn from 72 AMI patients within 6 hours after the onset of AMI. CAG revealed thrombolysis in myocardial infarction grades (TIMI) 0 to 1 in 56 and TIMI 2 to 3 in 16 patients (spontaneous reperfusion). No patients had received thrombolytic therapy before admission. TIMI 0 to 1 patients were characterized with lower Mb levels than TIMI 2 to 3 patients at admission (346 +/- 476 vs 1558 +/- 2005, mean +/- SD, p < 0.001). Furthermore, the mean Mb0/CK0 ratio in TIMI 2 to 3 patients, who had already achieved the reperfusion at admission, was significantly higher than that in patients with TIMI 0 to 1 patients (6.5 +/- 3.9 vs 2.1 +/- 1.8, mean +/- SD, p < 0.0001). When Mb0/CK0 > 5.0 was assumed to indicate the sufficient reperfusion at admission, the sensitivity, specificity, and accuracy evaluating the reperfusion status were 75%, 96%, and 92%, respectively. It can be concluded that the reperfusion status can be predicted satisfactorily by a single blood sample obtained at the time of admission without CAG.

[Risk factors for coronary artery disease in Japanese patients with chronic renal failure].

We examined the records of 101 Japanese patients with chronic renal failure (CRF) to determine the influence of established risk factors on the incidence of coronary artery disease (CAD). CAD was found in 25 patients (myocardial infarction in 18, significant coronary artery stenosis by coronary angiogram in 16). In patients with CAD, there were significantly more male (80% vs 58%, p < 0.05), more smokers (80% vs 41%, p < 0.0005), more diabetics (68% vs 32%, p < 0.005) and more hypertensives (92% vs 76%, p < 0.05). However, lipoprotein (a), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or triglycerides were not significantly different between CAD group and control group. When significant risk factors were entered into a stepwise logistic regression analysis, we found a history of smoking (p = 0.0025) and the presence of diabetes (p = 0.0141) to be independent risk factors for the presence of CAD in Japanese patients with CRF.