Swift and definite serotyping for isolated Listeria monocytogenes strains.

The serotype is most important for molecular epidemiological analysis of Listeria monocytogenes (L.m.) contaminating marketed meats. An improvement on the traditional method was thus attempted in the present study because of the requirement of swift and definite serotyping. In the determination of O-antigen, definite judgement was allowed by an immediate cooling at 80 degrees C after autoclaving the bacteria. In the determination of H-antigen, use of a culture plate without Craigie's tube yielded the active bacteria only by single culture. The stable and clear agglutination in many samples was also obtained with a microplate using less antiserum. The availability was confirmed with 123 strains and the serovar 1/2b was dominant in the Japanese strains.

[Efficacy of axillary-axillary bypass grafting for the subclavian artery disease].

Axillary-axillary bypass procedure was performed in 5 patients (3: atherosclerosis, 1: rupture of aortic arch aneurysm, 1: trauma) with the total occlusion of the subclavian artery. All the operations were performed with 6 mm ringed expanded polytetrafluoroethylene under general anesthesia. Though several types of extrathoracic procedures such as carotid-subclavian bypass, subclavian-subclavian bypass and axillary-axillary bypass are introduced, the efficacy of axillary-axillary bypass procedure is greater ease of anatomic exposure with no concern of interfering with the carotid circulation. The type of bypass to be used in a given case will depend on the individual circumstances. We suggest that this procedure is minimally invasive as well as effective for subclavian artery occlusion depending on the case.

Primary leiomyosarcoma of the pulmonary artery mimicking massive pulmonary thromboembolism.

A 57-year-old man with dyspnea and dry cough exhibited pulmonary embolism. Pulmonary arteriography demonstrated absent perfusion of the left main and the right upper and middle lobe pulmonary arteries. A diagnosis of chronic pulmonary thromboembolism was assumed and surgical thromboendarterectomy was attempted under standard cardiopulmonary bypass. At operation, a tumor had invaded far into both the right and left pulmonary arteries and radical resection was impossible. The final pathological diagnosis was primary leiomyosarcoma of the pulmonary artery. The patient refused any adjuvant therapy and died 63 days after the surgery. The clinical presentation of this case was similar to that of pulmonary thromboembolism and its diagnosis and treatment were very difficult.

[Evaluation of right ventricular function by intraoperative transesophageal echocardiography for patients with left ventricular dysfunction].

We evaluated right and left ventricular function by intraoperative transesophageal echocardiography for the patients with left ventricular dysfunction (left ventricular ejection fraction (LVEF) < or = 40) who underwent isolated coronary artery bypass grafting (CABG). We divided these patients into two groups; group 1 who had difficulty of weaning from cardiopulmonary bypass due to hypotension (n = 8) and group 2 who did not have any difficulty of it (n = 17). Basement characteristics (age, gender, history of myocardial infarction, congestive heart failure, LVEF, severity of the right coronary artery disease) of both groups were not different significantly. Intraoperative characteristics (the number of distal anastomoses, duration of aortic cross-clamp and cardiopulmonary bypass, and bypass to the right coronary artery) were also not different between two groups. However, mean duration of ICU stay and in-hospital mortality were significantly longer and higher in group 1 than group 2. On the other hand, right ventricular systolic function was severely impaired, particularly postoperatively, in group 1 compared with group 2. Right and left ventricular systolic function of group 2 was fairly improved postoperatively. These results may indicate that right ventricular dysfunction is a potent predictor of postoperative morbidity and mortality for the patients with left ventricular dysfunction who undergo isolated CABG.

Influence of peripheral vascular occlusive disease on the morbidity and mortality of coronary artery bypass grafting.

The impact of peripheral vascular occlusive disease (PVD) on outcome for patients who have undergone coronary artery bypass grafting (CABG) was assessed by comparing preoperative and intraoperative patient characteristics and outcome in 2 groups of patients who underwent CABG (patients with PVD, n=96; patients without PVD, n=593). Patients with PVD were significantly older (69+/-8.4 vs 63+/-8.7; p<0.0001), and had a higher incidence of diabetes mellitus (48% vs 32%; p<0.01), hypertension (62% vs 46%; p<0.01), preoperative cerebral infarction (26% vs 12%; p<0.001) and chronic renal dysfunction (11% vs 4.4%; p<0.01) than those without PVD. Postoperative morbidity and mortality were assessed, after those risk factors were adjusted, using multivariate logistic regression analysis. The perioperative myocardial infarction (PMI) rate and in-hospital mortality rate were significantly higher in patients with PVD than in patients without PVD (9.4% vs 3.0%; p=0.0108, 17% vs 2.7%; p=0.0003, respectively). The odds ratio of PMI and in-hospital mortality were 3.4 (95% confidence intervals (CI): 1.3-8.6) and 4.3 (95% CI: 2.0-9.5), respectively. Although the excess mortality rate was mainly the result of cardiac problems, such as low output syndrome or arrhythmia, in most of the cases, PVD, which may frequently prevent the use of the intraaortic balloon pump, also seemed to have a strong relation to postoperative morbidity and mortality.

Pulmonary hypertension caused by medial hypertrophy associated with aortic stenosis and preductal coarctation.

A 7-month-old female infant with aortic stenosis, preductal coarctation, and pulmonary hypertension underwent operation. Intraoperative lung biopsy revealed marked medial hypertrophy of the pulmonary arterioles. This histopathology is compatible with persistent pulmonary hypertension in the newborn. She is alive about 5 years after the operation, but pulmonary hypertension remains. The pathogenesis is discussed.

The proper use of glue: a 20-year experience with the GRF glue in acute aortic dissection.

BACKGROUND: In 1977, the use of Gelatine-Resorcine-Formaline (GRF) biological glue during surgery of acute Type A aortic dissection was proposed. The present study retrospectively analyzes the late results obtained with this adjunct in an experience extending over a twenty-year period of time. PATIENTS AND METHODS: From January 1977 to March 1996, 171 patients (124 males and 47 females) aged from 15-79 years (mean age: 53 +/- 14 years) underwent an emergency operation for type A aortic dissection in our institution. All patients suffered from acute type A dissection and 144 (84%) were operated on within 48 hours after the onset of symptoms. Twenty-six patients (15.2%) had Marfan's syndrome. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue. In 39 patients (23%), the aortic valve was replaced either independently (5 cases, 3%) or by means of a composite graft (34 cases, 19.8%). Because of the location of the intimal tear, the aortic replacement was extended to the transverse arch in 58 patients (33.9%). RESULTS: Hospital mortality amounts to 21% (36 patients), 22.8% in patients with arch replacement and 21.1% in patients without arch replacement (n.s). One hundred thirty-five patients were discharged and surveyed from 2 months to 19 years postoperatively (cumulative follow-up: 856 patients/years. Mean follow-up: 79 +/- 66 months). During this period of time, 22 patients (16.1%) had to be reoperated on for a total of 28 reoperations. Six of those (27.2%) died at reoperation. At univariate analysis, presence of Marfan's syndrome (p < 0.05) and absence of arch replacement (p < 0.02) were determinant risk factors for reoperation. Emergency (p < 0.01) and thoracoabdominal replacement (p < 0.04) were determinant risk factors of death at reoperation. The acturial freedom from reoperation (Kaplan-Meier, CI: 95%) is: 96.08% (90.9-98.2), 87.6% (79.8-92.7), 80.9% (70.8-86.1), 66.4% (51.1-78.9) at 1, 5, 10, and 15 years respectively. A total of 36 patients (27.7%) died during follow-up. Presence of Marfan's syndrome (p < 0.01), reoperation (p < 0.02), stroke (p < 0.05), cardiac failure (p < 0.05) were determinant risk factors of late mortality. The actuarial late survival rate (K-M. C.I.: 95%), including hospital mortality, is: 71.5% (64.3-77.8), 66% (58.3-73), 56.4% (47.7-64.7), 46.3% (36.4-56.5) at 1, 10 and 15 years. CONCLUSIONS: The GRF glue has proved to be extremely useful during emergency initial surgery for acute type A dissection, making the procedure much easier and safer. Through this operative improvement, the use of the GRF glue seems to have a beneficial influence on the late results which however, depend mainly on the patient's basic condition.

Protection against reperfusion-induced arrhythmias by human thioredoxin.

Adult T-cell leukemia-derived factor (ADF), identified in the supernatant of adult T-cell leukemia (ATL) cell culture, is a human homologue of thioredoxin and consists of 104 amino acids; it has two redox-active half-cysteine residues in an exposed active center. Human thioredoxin has many biological activities, including growth promotion, cell activation, and a catalase-like radical scavenging activity. We examined the protective effect of human thioredoxin (h-thioredoxin) against reperfusion-induced arrhythmias in an isolated rat heart model with 10-min regional ischemia followed by 30-min reperfusion. Male Wistar rats were assigned to six groups: a control, a superoxide dismutase (SOD 8 x 10(4) IU/L), and a catalase group (1 x 10(6) IU/L), and three groups treated with h-thioredoxin [approximately .01 microM (TRX-I group), approximately 0.1 microM (TRX-II group), and approximately 1 microM (TRX-III group)]. In the early reperfusion period, h-thioredoxin reduced the incidence of ventricular fibrillation (VF) to 8% in the TRX-II group (p < 0.01) from the control value of 75%. SOD and catalase reduced the incidence of VF to 43 and 33%, respectively (NS). During the entire reperfusion period, the incidence of VF in the SOD group was 79%, as compared to 83% in the control group. In the catalase and TRX-II groups, the incidence of VF was significantly reduced to 42 and 25%, respectively. These findings indicate that SOD failed to protect against the reperfusion-induced arrhythmias. h-Thioredoxin exerted a protective effect against these arrhythmias; a concentration of approximately 0.1 micro was the most effective.

[Surgical treatment of congenital aortic stenosis by aortoseptal approach].

Between 1975 and 1994, six patients under 15 years old with congenital aortic stenosis underwent relief of left ventricular outflow tract obstruction (LVOTO) by aortoseptal approach. Although we got satisfactory relief of LVOTO in all patients, there were two late deaths. In one patient with residual ventricular septal defect (VSD), intractable ventricular arrhythmia developed 12 years postoperatively. Although the residual VSD closure was performed, the patient died of the arrhythmia. The another one who was the youngest 4-year-old boy suddenly died 4 months postoperatively. The detail about his death was unknown, but we presumed ischemic heart attack as the cause of his death. In 3 of remaining survived 4 patients, we encountered a few complications. They were right ventricular outflow obstruction, coronary artery injury and conduction system injury. All complications and problems we encountered in this series were related to the incision and the reconstruction of aortoseptal approach. In conclusion, the aortoseptal approach is effective technique for relief of LVOTO, but on the other hand it is invasive and not so safe operation. So we should be cautious about these complications and problems.

Hepatic circulation during nonpulsatile cardiopulmonary bypass.

The arterial ketone body ratio, which reflects the hepatic mitochondrial redox potential (NAD+/NADH), decreases markedly during cardiopulmonary bypass (CPB). One of the reasons for arterial ketone body ratio reduction may be hepatic hypoperfusion during CPB. To evaluate the hepatic circulation under nonpulsatile CPB, the authors used color Doppler ultrasonography to measure the portal venous flow (PVF) in 24 adult patients before, during (aortic clamping and rewarming period), and after CPB. Nonpulsatile hypothermic CPB was performed at a flow rate of 2.4 L/min/m2. PVF was calculated from the product of mean flow velocity and cross-sectional area of the portal vein. PVF was maintained during CPB at 0.44 +/- 0.13 and at 0.54 +/- 0.18 L/min/m2. PVF (%) in relation to systemic blood flow was obtained by calculating PVF/CI or PVF/PI, where CI is the cardiac index and PI is the perfusion index. PVF (%) before, during, and after CPB was 18.3 +/- 9.3, 18.5 +/- 5.5, and 17.4 +/- 6.7%, respectively. In conclusion, PVF was maintained during nonpulsatile CPB at a flow rate of 2.4 L/min/m2 and depended upon systemic blood flow.

Antitumor effect of biological response modifier, PSK, on C57BL/6 mice with syngeneic melanoma B16 and its mode of action.

The effects of PSK, a protein-bound polysaccharide, on the survival period and effector cell activity were examined using C57BL/6 mice with melanoma B16. PSK prolonged the survival period of the mice with tumors in a schedule- and dose-dependent manner. However, no life-prolonging effect was observed when carrageenan-treated mice or congenitally athymic mice were used as hosts. PSK enhanced the cytostatic activity and interleukin-1-producing capacity of peritoneal exudate plastic-adherent cells in C57BL/6 mice with tumors. These findings suggested that PSK prolongs the survival period of mice with B16 tumors through T-cell- and macrophage-dependent mechanisms.

[A case report of left ventricular myxoma].

We reported a case of successful surgical extirpation of a left ventricular myxoma arising from the anterior wall of the left ventricle. A 17-year-old asymptomatic boy had been followed due to premature ventricular contractions. Two-dimensional echocardiography revealed a small mass in the left ventricle. He underwent transaortic extirpation of the mass under extracorporeal circulation in November, 1989. The gelatinous mass of 11 by 9 by 5 mm and weighing 0.4 g was a myxoma pathohistologically. His postoperative course has been uneventful. Left ventricular myxomas are very rare. In the literature, 26 cases in English and 6 in Japanese have been reported. Recurrence was reported in one case, thus careful follow-up is necessary.

Enhancement of effector cell activities in mice bearing syngeneic plasmacytoma X5563 by a biological response modifier, PSK.

We investigated the effect of PSK, a protein-bound polysaccharide obtained from Coriolus versicolor of basidiomycetes, on antitumor immunity in tumor-bearing mice. PSK prolonged significantly the life span of C3H/He mice bearing syngeneic plasmacytoma X5563 in a schedule- and dose-dependent manner. PSK was most effective when administered at 100 mg/kg every other day ten times starting from the day after tumor inoculation. The administration of PSK enhanced significantly the cytostatic activity of peritoneal exudate plastic-adherent cells and the cytolytic activity of spleen cells after in vitro incubation with mitomycin C-treated tumor cells. In addition, PSK restored the cytokine-producing capacity of spleen cells suppressed in tumor-bearing mice after in vitro incubation with mitogen. Sera from tumor-bearing mice suppressed the activity of such effector cells as well as the interleukin 2-producing capacity of spleen cells, but sera from PSK-treated tumor-bearing mice prevented this suppression. These results suggest that PSK enhances antitumor immunity by reducing immunosuppressive activity of serum from tumor-bearing mice.

Systemic venous aneurysms.

A case of superior vena cava aneurysm combined with aneurysm of the left innominate vein is presented. For the diagnosis, it is important not only to apply imaging techniques such as superior vena caval angiography, radioisotopic angiography, and computed tomographic scans but also to have a concept of this entity in mind.

[Serum and tissue concentrations of UFT in patients with lung cancer].

Postoperative serum and tissue concentrations of 5-FU, FT-207 and uracil were measured in 36 patients with lung cancer who were administered UFT for seven days preoperatively. The concentration of 5-FU was high in tumor tissue and lymph nodes, but very low in serum. Such differences were not observed in the FT-207 levels. Tumor concentration of 5-FU in patients administered daily doses of 600 mg was 0.151 +/- 0.099 microgram/g which was three times higher than the minimum inhibitory concentration, and higher than that seen with other doses. The histological type and T factor were not related to the tissue concentration of 5-FU. Lymph node metastasis was not related to the concentration of 5-FU in the lymph nodes. The optimal daily dose of UFT for patients with lung cancer was considered to be 600 mg.