Lactoferrin (Lf) can be purified by a technique utilizing its affinity for β-lactoglobulin (βLg) .Human colostrum was analyzed by high-performance liquid chromatography. Determination of Lf by enzyme-linked immunosorbend assey in each of the fractions revealed that, in addition to the fraction corresponding to the Lf (80 kDa ; fraction A), a large amount of Lf was also detected in another fraction of very large molecular weight (800 kDa; fraction B) . The two Lf-containing fractions were analyzed by affinity chromatography using a Sepharose 6 B-anti-human Lf : IgG binding column. With the retained specimen, sodium dode-cylsulfate polyacrylamide gel electrophoresis was performed on a 12.5 % gel. Only protein that was identical to Lf was separated from fraction A, while another protein (18 kDa) with the same mobility as bovine β Lg was detected in large quantities in fraction B in addition to Lf. Fraction B was treated with 0.3 M NaCI, which is thought to cleave Lf-βLg binding during Lf purification, and with 1.0 M NaCl salt at a higher concentration. This result suggests that Lf and β Lg are strong bound in milk. Bovine β Lg was purified by both affinity chromatography and ion exchange chromatography. Each of the two β Lg samples was allowed to react with human or bovine Lf, after which the specimens were analyzed by electro-phoresis. Some β Lg showed affinity for Lf while some β Lg did not, suggesting the existence of at least two types of β Lg. With the same specimens (produced by the reaction between bovine fi La and human or bovine Lf), gel chromatography revealed a peak at the position of fraction B separated from milk, but the area was not as large as that of fraction B. Therefore, the binding of Lf and β Lg in the substance obtained from in vitro reaction of Lf with β Lg does not appear to be as strong as that in milk.

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The total number of new patients who visited our department during the past 10 years was 75, 639; an average per year of 7, 563.9. The average has been rising since 1988. The number of male and female patients is almost equivalent, but changes are seen in some age groups. More males tend to visit than females until the 30s, but among patients aged 40 years and older, woman outnumber men. By ailment classification of new patients, traumatic injuries were most common, followed by sinal cord and inflammatory disease. The total number of inpatients during the past 10 years was 5, 943; an average of 594.3 per year. By ailment classification, traumatic injuries were most common : 2, 689 cases, which amounts to 45.2 % of the whole.

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The purpose of this study was to clarify the morphological changes of vessels after acute compression injuries. Twenty adult female Japanese white rabbits were used for this study. Acute double compression of the sciatic nerve was produced with a disposable vascular clip (holding force, 60 gms ; blade width, 2 mm) . Microangiography was performed to study the morphologic vascular changes in the epineurium and endoneurium. Histologic sec tions for examination were stained with by hematoxylin and eosin, elastica van Gieson, and neurofilament stain. In the epineurium, five or six arteriolar vessels were oriented longitudinally and formed a characteristic pattern on microangiography. In the endoneurial space, there was a microvascular network consisting of approximately six longitudinally arranged vessels. There were about twenty endoneurial vessels in all compression experiments after both 2 weeks and 4 weeks. Numerous small vessels were observed in the deep layer of epineurium after both 2 weeks and 4 weeks. Degeneration of large myelinated fibers appeared 2 weeks after 10 or 20 minutes of compression. This degeneration was also observed after 4 weeks. Two weeks after 30 or 60 minutes of compression, degeneration was more severe. After 90 minutes of compression, few axons remained.

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To establish a reliable anastomosis after cervicothoracic esophagectomy, a different type of narrow gastric tube was made with a surgical stapler. This new type of gastric tube was made along the greater curvature of the stomach and is 3 cm wide at the center and 5 cm wide at the tip (anastomosis site) . In the present study, length, wound healing, and viability of the narrow gastric tube was experimentally and clinically examined and compared with those of the whole gastric tube.
The extension rate was calculated by comparing the length of the narrow gastric tube with that of the intact stomach in dog experimental models ( n =12) . The blood flow volume at several distances from the pylorus was measured by Laser Doppler velocimetry. The blood flow volume of the narrow gastric tube was compared with that of the whole gastric tube. In addition, the reduction rate of the gastric tube was calculated by comparing the length before and after the seromuscular suture was applied. Histopathologic examination of the suture line made with the stapler along the tube, was performed at 3, 5, 7 and 14 days after surgery (n = 20) . In addition, a pressure tolerance test was performed (n = 31) .
In seven patients, blood flow and length of the narrow gastric tube were compared with those of the whole gastric tube. In addition, the extension rate of the narrow gastric tube was measured.
In the dog experimental model, the narrow gastric tube was significantly longer than the whole gastric tube (26.8±3.4 cm and 19.9±1.7 cm, respectively ; P <0.01) . The extension rate was 34.5±9.6%. The blood flow volume was 3.69±0.48 volts at the tip of the narrow gastric tube and 2.58±0.32 volts at the tip of the whole gastric tube (P <0.01) . The reduction rate after seromuscular sutures was 7.7±0.8%. Histopathological examination showed that submucosal vascularization and granulation after necrosis of the mucosa occurred by the 5th day, and that the submucosal and muscular layers became stratified, followed by fibrosis and submucosal vascular connections, 7 days after surgery. On the 14th day, advanced fibrosis and epithelized mucosa was seen. Seven days after surgery, pressure resistance with and without seromuscular suture was 176.1±29.8mmHg and 120.0±26.6mmHg, respectively (P <0.01) . On the 14th day, however, pressure resistance with and without seromuscular suture were almost identical (231.4±24.1mmHg and 247.8±16.8mmHg, respectively) .
In patients, the length of the narrow gastric tube and the whole gastric tube were 38.2± 3.2cm and 26.4±1.9cm, respectively (P <0.01) . The extension rate was 39.6±5.1%. The blood flow volume of the narrow gastric tube 25cm from the pyloric ring was significantly higer than that of the whole gastric tube (P <0.01) . However, the blood flow volume of the narrow gastric tube 35cm from the pyloric ring was 3.66±0.23 volts compared with 3.64±0.01 volts at the tip of the whole gastric tube.
These results indicate that the narrow gastric tube is superior with respect to length extension and viability compared with the whole gastric tube, and is suitable for reconstruction after cervicothoracic esophagectomy. Results of pressure resistance measurements of the narrow gastric tube suggest that adequate early postoperative decompression is necessary when this surgical technique is employed in clinical practice.

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The teratogenic effects of vitamin A have been described by several authors. An experimental study was conducted to analyze variations in craniofacial morphology in rat fetuses with cleft palate due to hypervitaminosis A, and to examine the effect of vitamin A on the movement of the palatine shelves. Pregnant W istar rats purchased from Saitama Medical Experimental Research were used. On days 9, 10, and 11 of pregnancy, 10, 000 units of vitamin A per 100 g of body weight was administered. A group of pregnant rats that were not treated with vitamin A was used as a control. They were killed on the 21 st day to observe the fetuses. No sex differences were observed in the frequency of cleft palate or in body structure or the size of the cranium. There was a significant sex difference in the movement of the palatine shelves. Hypervitaminosis A was shown to affect palates of females more severely than the palates of males.

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We compared the effects of isoflurane and halothane=induced hypotension on carbohydrate metabolism in dogs. Eighteen mongrel dogs were anesthtized with pentobarbital intravenously and randomly divided into two groups : a halothane group (n=8), which received 0.9% halothane in oxygen, and an isoflurane group (n=8), which received 1.3% isoflurane in oxygen. The inspired concentration of halothane or isoflurane were increased to decrease mean arterial pressure to 60mmHg, which was maintained for 60 minutes. Hemodynamic parameters and arterial blood gases were measured and blood samples for determination of level of glucose and lactic acid were collected before, during, and after hypotension. Blood glucose levels in the both groups remained unchanged throughout the observation period. Lactic acid increased significantly during and after hypotension in the halothane group : however, it did not change significantly in the isoflurane group. Arterial pH, PaCO₂, and base excess in the isoflurane group remained unchanged hroughout the observation period. Base excess in the halothane group decreased significantly during and after induced hypotension. In both groups, PaCO₂ decreased significantly during hypotension but returnred to the baseline value, after hypo. tension. These results suggest that carbohydrate metabolism is affected less by isoflurane=induced hypotension than by halothane-induced hypotension. We conclude that isoflurane preserves peripheral circulation during profound hypotension and suggest that isoflurane-induced hypotension can be employed safely in clinical situations.

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Video-assisted thoracic surgery (VATS) is rapidly replacing standard thoracotomy in the evaluation and treatment of intrathoracic diseases. Video-assisted thoracic surgical lung biopsy has become a common alternative to open lung biopsy for diagnosis of localized and diffuse lung diseases. Recently developed thoracoscopic surgical equipment and related instruments have enabled thoracoscopic surgical procedures to be improved. VATS was performed in 60 cases in our department from November 1992 to December 1994. The indications for VATS were spontaneous pneumothorax (41 cases), interstitial lung disease (5 cases), benign lung tumor (3 cases), malignant lung tumor (3 cases), mediastinal tumor (2 cases), mediastinal lymph node swelling (2 cases), pleural tumor (2 cases), and pleuritis of unknown cause (2 cases) . We conclude that VATS is especially useful in the diagnosis and management of pneumothorax, diffuse lung disease, mediastinal and chest wall tumors, pulmonary nodule, pleuritis, and cardiovascular diseases.

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Endoscopic adrenalectomy with wide endoscope, which was first reported a few years ago, was performed in three cases of left adreno-cortical adenoma with hypertension. The patient was a was 59-year-old man and 53- and 54-year-old women. The size of tumor in each patient was approximately 2 cm. Intraoperative blood loss during wide endoscopic adrenalectomy was ranged from 128 to 313 ml, and duration of surgery ranged from 2 to 4 hours. The length of the skin incisions in each case was 5 cm. These data show that this new minimally invasive surgical procedure has some benefits compared with conventional open and laparoscopic surgery. In addition, our favorable results suggest that intraorerative ultrasound examination will make it easy to detect small adrenal tomors in the deep retroperitoneal adipose tissue.

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To perform D3 lymphadenectomy in cases of sigmoid colon cancer or rectal cancer, it is necessary to section the root of the inferior mesenteric artery (IMA), the distal left colicartery, and the sigmoid artery. To releconstruct the intestinal tract after lymphadenectomy it is necessary to section the adoral intestinal tract ; anastomosis must, ther of one, be performed at either the left colicartery or at the sigimoid colon, where peripheral arteries are preserved. To sucessfully perform lymphadenectomy in the IMA region and improve blood flow in the remaining intestinal tract, it is setter to preserve the IMA than to cut the root of the IMA. For sucessful lymphadenectomy in the IMA region, it is necessary to first identify the lymphadenectomy area. The lymphadenectomy area is identified by creating a hole in the mesentery about 1.5 cm above the root of the IMA where the aorta is attached to the mesenteries of the descending colon and the sigmoid colon, and then isolating the mesentery approximately midway between the peripheral arteries and the branching of the left colicartersy. Successful lymphadenectomy can be performed by separating the peripheral tissues from the IMA at the branch between the left colicartery and the sigmoid colon, thereby enabling the lymph nodes in the IMA region to be removed as a single mass. This paper presents a method of main artery lymphadenectomy which preserves the inferior mesenteric artery and the left colicartery in patients with rectal cancer.

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A 41-year-old man visited our hospital because of a penile mass that had first been noted 3 years earlier and had gradually grown. On physical examination, there was a darkpurple mass on the dorsal aspect of the glans penis. Clinical diagnosis was hemangioma of the glans penis. The hemangioma was successfully resected and histopathologically diagnosed as venous hemangioma. Hemangioma of the glans penis is a rare tumor. Only 32 cases have been reported in Japan. Many treatments have been reported for hemangiomas of the penis. We believe that surgical excision is the most common and successful therapy to rule out malignancy.

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A 49-year-old man was referred from Shiroyama Hospital, owing to renal infarction after DeBakey IIIb aortic dissection. We decided to operate 10 days after onset, because there was no improvement after a window was made with a catheter between the true and false lumen. We replaced a section of the descending aorta with a knitted Dacron Graft (26 mm) under venoarterial bypass. After the operation, visceral ischemic changes did not improve, and the patient died of multiple organ failure on the 15 th postoperative day. Findings at autopsy indicated : (1) More than 80 % of the intestine was necrotic, (2) diameter of the distal anastomosis was small, (3) the orifices of the branches of the abdominal aorta were widely patent with no evidence of arteriosclerosis. To obtain the best results, a dissecting aneurysm should be properly removed and reconstruction of blood flow should be adequately reconstructed. Any postoperative residual aneurysm and the condition of the viscera should be monitored carefully and, reconstruction of abdominal aortic branches, if necesary should be performed immediately.

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A rare case of prosthetic valve endocarditis (PVE) due to Candida albicans was successfully treated by systemic administration of fluconazole. A 56-year-old man who had undergone mitral valve replacement (26 mm SJM valve) 7 years ago was treated with multiple antibiotics after resection of an ileocecal tumor. Postsurgical cultures of arterial blood were repeatedly positive for Candida albicans, and echocardiography revealed a giant vegetation on the artificial valve. The patient was referred to our hospital with no clinical thrombogenic manifestations, but a smaller vegetation was detected with echocardiography. Fluconazole was administered at a dose of 200 mg/day for 14 days, after which blood cultures were negative. The endpoint of antifungal therapy is debatable. We think patients should be monitored with serologic tests, such as Candida antibody and D-arabinitol, for at least 1 year.

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