Prolongation of allograft survival with Ling Zhi-8, a new immunosuppressive drug.
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Adjuvants, Immunologic↗
Biomedical subjects
K Kino
Publications and source records attributed to K Kino.
[A case of emergent surgical salvage for the mitral prosthetic perivalvular leakage diagnosed only by the transesophageal Doppler echocardiography].
A case of the successful emergency surgery for the mitral prosthetic perivalvular leakage (PVL) which was diagnosed only by the transesophageal Doppler echocardiography (TEE) is reported. A 59-year-old male who had been diagnosed MS + TR + severe PH underwent mitral valve replacement with St. Jude medical valve 27 M. On the eighteenth postoperative day hemoglobinuria was noticed suddenly. Subsequently hemolysis and nonoriguric renal failure was aggravated, then we suspected PVL, but heart murmur was not audible or PVL could not been detected by the transthoracic echocardiography (TTE). PVL was detected for the first time by the TEE, then open heart resuture was emergently performed. The site of the PVL was the portion where the anterior mitral annulus adjoined the aortic annulus, that is, adjacent to the right fibrous trigone. This site is the portion which a surgeon should treat very carefully and where the PVL is very difficult to detect by the TTE. In regard to the detection of the PVL in mitral position, the TEE, which has ultrasonically no flow masking by the mitral prosthesis, is the very useful diagnostic means.
Echocardiography, Doppler↗
Spontaneous secure reimplantation of a dislodged pacemaker electrode onto the right ventricular outflow tract, reestablishing a sufficient pacing condition.
A 62-year-old woman underwent cardiac pacemaker implantation for sick sinus syndrome with bradycardia, and the tip of an endocardial tined lead was positioned to the right ventricular apex. On the fifth postoperative day, an incomplete pacing failure, lasting about 10 min, was observed transiently on 24-h monitoring. This event, however, was not considered to be a clinical manifestation of the ensuing complication until the patient visited our pacemaker clinic 2 months postoperatively. At that time, a chest x-ray demonstrated that the electrode tip had migrated markedly to the right ventricular outflow tract (RVOT), but presented a sufficient pacing condition. The reimplantation site appeared to be very insecure for pacing, raising the potential risk of repeat dislodgement since the lead was not provided with a helix. At the second operation, performed to assess the problem, the ventricular excitation threshold measured at 1.3 V with a 0.5 ms pulse width. Furthermore, it was unexpectedly disclosed that the electrode tip was so tightly anchored at the site that it could not be withdrawn, eliminating the possibility of repeat dislodgment. Consequently, the entire original pacing system could be used as before and no further complications were observed. Although the situation encountered was very rare and seemed to be problematic, careful observation might be an alternative to surgical intervention even when a tined tip without helix has been used.
Electrodes↗
Ling Zhi-8: a novel T cell mitogen induces cytokine production and upregulation of ICAM-1 expression.
Ling Zhi-8 (LZ-8) is a protein purified from Ganoderma lucidium, a Chinese medicinal fungus thought to possess potent effects on the immune system. When examined for its effects on lymphocytes, LZ-8 exhibited potent mitogenic effects on human peripheral blood lymphocytes (PBL), inducing a bell-shaped dose-response curve similar to that caused by PHA and other lectin mitogens. Fractionation experiments indicated that the proliferative response in the PBL cultures was primarily due to T cells, but was monocyte dependent. Stimulation of PBL with LZ-8 resulted in the production of IL-2 and a corresponding upregulation of IL-2 receptor expression. In addition to T cell proliferation, microscopic examination of LZ-8-stimulated PBL revealed that LZ-8 induced cellular aggregate formation. The aggregate formation correlated with a dramatic rise in ICAM-1 expression and an increased production of IFN-gamma, TNF alpha, and IL-1 beta, molecules associated with regulation of ICAM-1 expression. Both the aggregate formation and the proliferative effects of LZ-8 were blocked by addition of monoclonal antibody to either CD18 or CD11a, the counterreceptor complex components for ICAM-1. Furthermore, addition of neutralizing antibodies to both IL-2 receptor and TNF alpha blocked aggregate formation, cellular proliferation, and ICAM-1 expression. These findings demonstrate that LZ-8 is a potent T cell activator, mediating its effects via cytokine regulation of integrin expression.
Antigens, CD↗
Reconsideration of the bilaminar zone in the retrodiskal area of the temporomandibular joint.
The fibrous connection of the diskal attachment to the condyle and to the surrounding structures, and of the retrodiskal area was investigated histologically. Sections, obtained from six temporomandibular joints with the condyle protruded, were mainly observed. Most of the collagen fibers that compose the posterior band were attached to the condylar poles and to those vicinities behind them, and no diskal attachment was found to the posterior aspect of the condyle. Elastin-rich fibers that originate from the petrotympanic fissure were attached to the disk at the medial end. These fibers had many branches that compose a part of the retrodiskal area and were very wavy in spite of the protruded position of the disk-condyle complex. No other fibers directly connected the disk with the posterior wall of the fossa. Therefore we concluded that there were no upper and the lower strata as termed by Rees.
Adult↗
Circulatory support for patients experiencing postcardiotomy cardiogenic shock: analysis of risk factors for death and long-term follow-up.
Over the last 5 years, 12 patients received ventricular assist devices (VADs) while in postcardiotomy cardiogenic shock. There were 7 male and 5 female patients ranging in age from 22 to 73 years (average age, 54). Eight patients underwent surgery for valve replacements, 3 for coronary artery bypass graftings, and 1 for closure of a ventricular septal rupture. The duration of VAD support ranged from 6 h to 9 days (mean, 4.2 days). Ten patients were weaned from the VADs, and 6 survived. Univariate analysis indicated that renal failure, infection, and heart failure had a negative impact on those patients who survived. Multivariate analysis indicated that heart failure, renal failure, and preoperative left ventricular ejection fraction were the most important predictors of hospital death. The 6 survivors were followed for 4 to 42 months (mean, 25 months); 5 were in New York Heart Association (NYHA) Class I, and 1 was in Class II. The cardiac functions in 5 patients who lived over 1 year were assessed by echocardiography. Preoperative and postoperative UCG revealed that ejection fraction and mean velocity of circumferential fiber shortening increased significantly (p < 0.01). Also, the left ventricular diastolic and systolic dimensions decreased significantly (p < 0.05). However, the patients did not show further changes in these parameters during exercise. Eight patients who had double valve replacements were observed for comparison (control group). In the control group, exercise improved cardiac output and mean velocity of circumferential fiber shortening (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiac Surgical Procedures↗
Mid-term results of bilateral internal thoracic artery grafting.
Forty patients underwent coronary revascularization using bilateral internal thoracic artery (ITA) grafts between 1988 and 1992. A total of 111 coronary grafts were performed, or an average of 2.8 grafts per patient. Each patient received bilateral ITA grafts, and in 20 patients an additional 29 grafts were constructed with 18 autologous veins and 11 gastroepiploic arteries. The right ITA was grafted as a free graft in 20 patients. The ITA graft patency rate was 96 per cent (67/70) at the time of hospital discharge. The operative morbidity included 3 reoperations for bleeding, 1 perioperative myocardial infarction, 1 renal failure, 2 postcardiotomy shock, and 1 colon perforation. Two hospital deaths occurred; one due to colon perforation and the other due to postcardiotomy cardiogenic shock. One patient died of cerebral infarction 6 month after the operation. Thirty-four patients were in New York Heart Association functional class I, 2 were in class II and 1 was in class III. Cardiac function evaluated by echocardiography and scintigraphy showed significant improvement postoperatively. These data suggest that the use of bilateral ITA grafts is associated with an acceptable mortality and increases the versatility of arterial grafting.
Aged↗
Efficacy of percutaneous transluminal coronary recannalization for preservation of the post-infarct left ventricular regional wall motion: a trial of the evaluation by weighting coronary artery segments.
Efficacy of the percutaneous transluminal coronary recannalization (PTCR) therapy was evaluated by weighting infarct-related coronary artery segments in 28 consecutive patients with acute myocardial infarction. The study focused on the influences of the time interval from the onset of chest pain to PTCR (PTCR-Time) and on the post-infarct left ventricular regional wall motion in conjunction with the serum levels of GOT, LDH and CPK and with PTCR-Time. PTCR success rate was 84.0%, and re-occlusion rate was 4.0%. The thrombolysis in myocardial infarction grade 2, however, was observed in 7 (33.3%) of 21 cases with successful PTCR. There was no significant difference in PTCR-Time between the PTCR success and nonsuccess groups. Significant correlations were observed between the PTCR-Time and each peak value of standardized serum levels of LDH and CPK, and between the PTCR-Time and the post-infarct regional wall motion abnormality. There were also significant correlations between the standardized serum level of each of these three enzymes and the post-infarct regional wall motion abnormality. It was clearly demonstrated that the earlier the recannalization of the infarcted artery was achieved, the less extensive the myocardial damage in quantitative and qualitative aspects.
Adult↗
[Gastric ulcer and patterns of distribution of intestinal metaplasia in the elderly].
Gastric ulcer was studied with regard to the relationship with patterns of distribution of intestinal metaplasia (IM). 882 stomachs of elderly patients, obtained from autopsies from 1987 to 1991 were examined histopathologically. There were 74 open gastric ulcers and 88 ulcer scars. Distribution of IM was classified into 7 types. Open ulcers and scars were found more often in type O (IM found in the entire lesser curvature which is the most common type in the elderly) than in other types. Open ulcers in type O were mostly shallow and located in the IM area. Many open ulcers in type A (IM involving the antrum) and type B (IM involving both the antrum and cardia) were deep and on the boundary zone between the IM area and the proper gastric mucosa area. Most of the deep scars that did occur in type O were in the IM area but in types B and A most of them were located on the boundary zone. Scars in type O probably developed on the boundary zone when they were open ulcers and removed in the IM area because of progression of the IM area. In some cases ulcers were at the boundary zone of IM involving the cardia and this finding was characteristic of elderly cases.
Aged↗
[Urgent mitral valve replacement for acute mitral regurgitation due to ruptured chordae tendineae in systemic lupus erythematousus].
We reported a successful surgical treatment of mitral regurgitation (MR) due to ruptured chordae tendineae in a 44-year-old man with systemic lupus erythematosus (SLE) who had received the steroid therapy. He had signs of acute congestive heart failure with severe pulmonary hypertension due to MR, and underwent urgent mitral valve replacement. The postoperative course was uneventful. When replacing valve in SLE, a careful manipulation should be taken because of friability of cardiovascular tissue. Patients are usually administered steroid agents, and the agents ought to be discontinued in perioperative period, but it seems to be better to resume as soon as possible. We conclude that the surgical treatment for valvular diseases should be considered, even in the patient with SLE.
Acute Disease↗
[Descending thoracic aorto-aortic bypass grafting for coarctation of the aorta in an adult combined with a cerebral arterial aneurysm--a case report].
Coarctation of the aorta (CoA) in adults is often accompanied by hypertension, but CoA combined with a cerebral arterial aneurysm is rare. We performed successfully descending thoracic aorto-aortic bypass grafting for CoA in an adult who had a cerebral bleeding and a cerebral arterial aneurysm. The patient was a 46-year-old female who had the history of hypertension. She suddenly suffered from left hemiparesis due to cerebral bleeding, then a left middle cerebral arterial aneurysm and CoA were detected at the same time. Aortography showed that the internal diameter of the portion of the coarctation was 2.8 mm and the poststenotic dilatation was prominent. The peak systolic pressure gradient across the coarctation was 60 mmHg. We took the precedence of the surgical repair for CoA over that for the cerebral arterial aneurysm, because her cerebral arterial aneurysm was judged to have less risk to rupture from the viewpoint of its size and shape by neurosurgeons. We performed proximal descending thoracic aorto-distal descending thoracic aortic bypass grafting with a woven double velour graft of 16 mm in internal diameter and 9.5 cm in length. Intraoperative cerebrovascular hypertension can be avoided by this procedure. Furthermore the peak systolic pressure gradient has disappeared immediately after grafting. In general, the coarctectomy with direct end-to-end anastomosis is prevalent for CoA in adults. On the other hand, the descending thoracic aorto-aortic bypass grafting for CoA in adults has rarely been reported.(ABSTRACT TRUNCATED AT 250 WORDS)
Aorta, Thoracic↗
Maleylated human serum albumin inhibits HIV-1 infection in vitro.
Maleylated-human serum albumin (Mal-HSA) inhibited human immunodeficiency virus type-1 (HIV-1) infection of MT-4 cells in vitro. It was also found to inhibit the fusion between uninfected CD4+ cells (Molt-4 clone 8 cells) and HIV-1 infected cells (Molt-4/HIV-1) to form syncytia. To investigate the mechanism of the inhibition, a study was designed to determine whether Mal-HSA could bind to CD4+ cells. Mal-HSA could bind to both MT-4 cells and Molt-4 clone 8 cells with high affinity, Kd = 2.0 nM and Kd = 5.8 nM, respectively. However, Mal-HSA could neither inhibit anti CD4 antibody Leu 3a binding to Molt-4 clone 8 cells nor modulate the expression of CD4 molecules on the surface of the cells. Mal-HSA binding to Molt-4 clone 8 cells was completely inhibited by sulfated polysaccharides bearing anti-HIV activity, such as dextran sulfate, fucoidan and carrageenan. Other HIV-1 susceptible human T-cell lines, such as Molt-4, CEM-5, H-9 and HuT-78 cells, also have Mal-HSA binding sites showing a high affinity, Kd = 0.9 +/- 0.4 nM. Mal-HSA binding proteins of Molt-4 clone 8 cells were identified by ligand blotting as 155 and 220 kDa proteins. Unlike dextran sulfate, Mal-HSA could not inhibit reverse transcriptase activity of HIV-1. These results indicate that Mal-HSA inhibits HIV-1 infection and syncytia formation, and suggest that 155 and/or 220 kDa proteins of target cells are involved in HIV-1 adsorption and/or the membrane fusion between HIV-1 and target cells.
Acquired Immunodeficiency Syndrome↗
An immunomodulatory protein, Ling Zhi-8, facilitates cellular interaction through modulation of adhesion molecules.
Ling Zhi-8 (LZ-8), a novel immunomodulatory protein, markedly enhanced the expression of CD11b, but not CD11a, CD13, CD14, CD18, CD33 or HLA-DR, on the U937 cell line in a dose-dependent fashion. It also induced ICAM-1 expression on vascular endothelial cells and significantly augmented gamma - interferon-induced cellular binding between vascular endothelial cells and U937. Furthermore, LZ-8 increased the expression of CD2, but not VLA4, VLA5 or LFA3, on MOLT4 and enhanced rosette formation between human T cells and sheep red blood cells. These data suggest that LZ-8 exerts its pharmacological effect by modulating adhesion molecules on immunocompetent cells.
Adjuvants, Immunologic↗
The use of a biventricular assist device for postcardiotomy profound biventricular failure.
A 58-year-old woman who could not be weaned from cardiopulmonary bypass was treated with a biventricular assist device (BVAD) using a centrifugal pump for the left side and a pneumatic pulsatile pump for the right side. At the initiation of the BVAD support, predominant right ventricular failure was recognized and therefore weaning was begun from the left side. The left ventricular assist device was discontinued after 87 h and the patient was finally weaned from the right ventricular assist device after 205 h. Despite the complete recovery of cardiac function, the patient developed renal failure followed by an intractable infection and died of multiple organ failure on the 59th postoperative day (POD).
Aortic Valve↗
Multivessel coronary revascularization with bilateral internal thoracic artery grafts.
Sixteen patients underwent coronary revascularization with bilateral internal thoracic artery (ITA) grafts between 1988 and 1989 at the Okayama University Hospital. A total 39 coronary grafts were performed, being an average of 2.4 grafts per patient. Each patient received bilateral ITA grafts, and in 5 patients an additional 7 grafts were constructed with 5 autologous veins and 2 gastroepiploic arteries. The right ITA was grafted as a free graft in 4 patients. The ITA graft patency rate was 96.8 per cent (31/32) at the time of hospital discharge. The postoperative morbidity included one reoperation for bleeding and one myocardial infarction. Coronary artery bypass grafting with bilateral ITA grafts can be safely performed and its application facilitates complete revascularization with arterial grafts.
Aged↗
Antilymphocyte antibodies against CD4+CD45R+ subsets in patients with IgA nephropathy.
The authors analysed CD4+ subset populations and particularly subset killing in order to evaluate the presence of antilymphocyte antibody against CD4+ subsets in patients with IgA nephropathy (IgA N). This study was performed in 45 patients with IgA N, 30 patients with other forms of glomerulonephritis and 30 healthy controls. CD4+, CD4+CD45R- and CD4+CD45R+ cells in the peripheral blood were counted by a flow cytometric analysis, and those cell killings were analysed by microcytotoxic assays. The percentage of circulating CD4+CD45R+ cells was significantly decreased in IgA N, and the percentage of CD4+CD45R+ cell killing was significantly elevated in IgA N compared with other groups. There was a significant negative correlation between the percentage of CD4+CD45R+ cells present in IgA N patients' peripheral blood lymphocytes and the killing CD4+CD45R+ cells by the same patients' serum. Both a depletion of CD4+CD45R+ cells in peripheral blood lymphocytes and an elevation of CD4+CD45R+ cell killing correlated with the grade of mesangial proliferation in patients with IgA N. However, there were no correlations in other clinicopathological indices. These results suggest that low levels of antilymphocyte antibodies against CD4+CD45R+ cells were present in patients with IgA N, who showed a depletion of CD4+CD45R+ cells in the peripheral blood. These antibodies were strongly associated with the elimination of CD4+CD45R+ cells and the proliferation of glomerular mesangial cells in patients with IgA N.
Adolescent↗
Influences of ventricular pacing on hemodynamics, myocardial metabolism, and cardiac work efficiency: potential risks of rate-responsive ventricular pacing.
The influences of ventricular pacing at a rate of 70 beats/min (bpm) on the systemic and coronary hemodynamics, myocardial metabolism, and cardiac work efficiency were evaluated in five patients with bradycardia. The results were compared to those obtained in six normal subjects at rest. In order to elucidate the effects of a relatively high rate of ventricular pacing, cardiovascular and metabolic variables were also obtained at 120 bpm in the normal subjects. It was observed that the patients eventually benefited from ventricular pacing at a rate of 70 bpm and improved in systemic hemodynamics. Although coronary hemodynamics and myocardial metabolism were accelerated, the cardiac work efficiency was not improved. A pacing rate of 120 bpm in the normal subjects did not appear to accelerate systemic hemodynamics, but adverse accelerations of coronary hemodynamics and myocardial metabolism were observed, and the cardiac work efficiency was remarkably reduced as a result. Our observations indicated that the coronary reserve capacity was very important for ventricular pacing, and suggested that an undue increment of the pacing rate not only might be meaningless but also might induce ischemic angina. Therefore, we should be cautious in using a rate-responsive pacing mode, particularly in determination of the upper limit of pacing rates, although many benefits with this pacing mode have recently been advocated.
Adult↗
[Stomal stenosis following gastrectomy in the elderly].
Seven hundred and thirty seven patients over 65 years of age (mean 76 years) undergoing gastrectomies from 1979 to 1991 were reviewed to evaluate the cause of stomal stenosis in the early postoperative period. Fifty seven (7.7%) patients, 24 males (5.6%) and 33 females (10.6%), had overt stomal stenosis or obstruction documented by radiological and endoscopic findings. The incidence of stenosis in females was significantly higher than in males (p < 0.05). Complications developed in 19 (20.0%) of 95 patients after gastroduodenostomy (Billroth-I), 29 (6.2%) of 465 after gastrojejunostomy (Billroth-II and others) and 8 (5.0%) of 159 after esophagojejunostomy (total gastrectomy). The incidence of complications in the first was significantly higher than in the other two (p < 0.01). The cause of stomal stenosis was classified into three groups; (1) transient stenosis due to stomal edema in 21 patients, (2) intestinal obstruction immediately adjacent to the stoma (kinking, invagination and volvulus) in 22, (3) organic stenosis of pathological origin (stomal ulcer, anastomotic leakage and strangulation by the proliferated mesocolon) in 14. The period of recovery from postgastrectomy retention was different in each group. It was 20.7 (mean) +/- 7.7 (SD) days in group (1), 29.7 +/- 12.6 days in group (2) and 62.1 +/- 30.0 days in group (3). These mean periods were significantly different from each other (p < 0.01). Group (1) and most of group (2) responded well to conservative management consisting of decompression by nasogastric suction and parenteral feeding but a reoperation was necessary for only two patients in group (2). Half of group (3) was treated by endoscopic dilatation and one third by reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗