Comparison of descending phlebography with quantitative photoplethysmography, air plethysmography, and duplex quantitative valve closure time in assessing deep venous reflux. To assess the role of noninvasive tests--quantitative photoplethysmography, air plethysmography, and quantitative duplex scanning, we compared a group of normal (group N, eight limbs) volunteers to patients with severe chronic venous insufficiency who were stratified according to the degree of reflux seen on the current "gold standard," descending phlebography. Group M (10 limbs) had mild (grades 0 to 2) reflux, and group S (10 limbs) had severe (grades 3 to 4) reflux as determined by phlebography. Quantitative photoplethysmography could identify normal from abnormal limbs but could not distinguish the severity of reflux. Air plethysmography was used to calculate venous filling index, ejection fraction, and residual volume fraction. Ejection fraction was the same in all groups. Venous filling index could not significantly distinguish the degree of reflux (group M vs group S) but increased as reflux increased. Residual volume fraction was considerably higher in group S. Quantitative duplex valve closure time was measured in the superficial femoral and popliteal veins, with the values added together in each limb to give a total valve closure time (TVCT). A TVCT value greater than or equal to 4 seconds correlated best with severe phlebographic reflux, with a sensitivity of 90%, a specificity of 94%, and an accuracy of 93%. This value was confirmed as the best test for venous reflux by receiver operating characteristic curve analysis. Thus in the evaluation of patients with severe chronic venous insufficiency who are candidates for phlebography and surgery, quantitative duplex measurement of TVCT gives the best noninvasive assessment of the severity of deep venous reflux.


Late complications of revascularization for radiation-induced arterial disease. During a 14-year period 23 patients underwent 25 revascularizations for radiation-induced arterial obstructive disease. An average of 5000 rads was delivered, 3 to 24 (mean 9) years before arterial insufficiency, for malignancies of the following origin: gynecologic (n = 9), lymphoma (n = 7), head and neck (n = 5), testicular (n = 1), and lower extremity sarcoma (n = 1). Arterial occlusive disease occurred in the aortic arch vessels (n = 8), visceral aortic vessels (n = 1), and aortofemoral vessels (n = 16). Presenting symptoms were claudication (n = 8), rest pain or nonhealing ulcers (n = 7), transient ischemic attacks (n = 6), asymptomatic bruit (n = 1), and renal insufficiency (n = 1). Reconstructive operations included anatomic bypass (n = 10), extra-anatomic bypass (n = 4), patch angioplasty (n = 5), endarterectomy (n = 3), and resection with interposition graft (n = 1). In this group of patients there were no major perioperative wound complications or other major radiation-associated morbidity. Five patients had late graft infections that manifested from 2 to 5 years after surgery. All occurred in anatomic regions where the bypass graft passed through previously irradiated tissues. Presenting symptoms of infection included a draining groin sinus (n = 3) or soft tissue abscess (n = 2). In all cases the graft had not incorporated into the surrounding tissues when passing through the irradiated area. Treatment included graft excision and extra-anatomic bypass through nonirradiated tissue. One patient died of systemic sepsis. Vascular reconstructive surgery can safely be performed for radiation-induced arterial disease.(ABSTRACT TRUNCATED AT 250 WORDS)


Carotid endarterectomy: a safe cost-efficient approach. The diagnosis-related groups have encouraged physicians to become more efficient in the care of their patients; often, however, raising the question of safety. For 3 years all patients undergoing carotid endarterectomy at our institution were monitored in the intensive care unit for 24 hours and the majority were discharged on the second postoperative day. After review of these patient's hospital records and direct patient interviews, it was clear that many patients did not require a stay in the intensive care unit and could be discharged on the first postoperative day. In January 1991 a prospective policy was established to evaluate the safety and efficacy of outpatient arteriography, same-day admission, selective use of the intensive care unit, and early discharge on the first postoperative day when feasible. During a 10-month period all patients undergoing carotid endarterectomy at our institution were evaluated (n = 52). Eleven patients had had a prior stroke (21%), 31 had either amaurosis fugax or transient ischemic attacks (60%), and 10 had no symptoms (19%). The arteriogram for 49 of the patients was obtained on an outpatient basis or during a prior admission, and these patients were admitted to the hospital on the day of operation. Nine patients were placed under general anesthesia and had shunting procedures, and 43 patients had cervical block anesthesia, eight of whom had shunting (19%). Only five patients required an intensive care unit stay for either hypertension, hypotension, or neurologic complication (one transient ischemic attack and one minor stroke). Forty-six patients (88%) were discharged on the first postoperative day; average length of stay was 1.29 days/patient.(ABSTRACT TRUNCATED AT 250 WORDS)


Routine postendarterectomy duplex surveillance: does it prevent late stroke? Our recent finding that less than 50% of late postendarterectomy strokes are related to recurrent carotid stenosis led us to question the utility of routine postendarterectomy duplex surveillance (RpCEADS) in the prevention of late stroke. To evaluate our RpCEADS program, we reviewed our postoperative duplex studies and correlated their results with clinical data. A total of 1053 postendarterectomy scans was carried out on 348 carotid arteries (258 patients) (3.0 +/- 0.1 studies/artery) during an average follow-up of 52.6 (+/- 2.3) months. Less than 50% of recurrent carotid stenosis was documented throughout follow-up in 292 (83.9%) of 348 arteries. Recurrent carotid stenosis of greater than 50% or occlusion of either the common or internal carotid artery was noted in the remaining 56 arteries (16.1%). Of the 56 duplex-detected recurrent stenoses, only two (3.6%) resulted directly in an unheralded stroke, whereas eight (14.3%) underwent prophylactic reoperation, eight (14.3%) resulted in transient ischemia requiring reoperation, eight (14.3%) occluded without causing stroke, and 29 (51.8%) remained asymptomatic and did not progress to occlusion. Assuming that each of our eight patients who underwent prophylactic reoperation would have had a stroke if operation had not been carried out and our two unheralded strokes could have been prevented with more rigorous follow-up, RpCEADS might have prevented late stroke related to 10 (2.9%) of 348 arteries in 10 (3.9%) of 258 patients after surgery. All other cases of duplex-detected recurrent carotid stenosis or occlusion were asymptomatic or manifest by transient cerebral ischemia. Therefore RpCEADS cannot be justified as a means of preventing late strokes related to recurrent stenosis.


The influence of age and sex on asthma admissions. To describe demographic data from a large population of asthmatic patients to define the role of age and sex as risk factors for asthma admission. A retrospective review of all asthma admissions as defined by International Classification of Diseases, Ninth Revision, code 493.0. All medical-surgical admissions from 67 hospitals in five counties of southeastern Pennsylvania from 1986 through 1989. Patients admitted for asthma treatment (33,269) were reviewed. In the 0- to 5-year-old and 6- to 10-year-old age groups, males were admitted nearly twice as often as age-identical females. In the 11- to 20-year-old age group, admissions for males and females were nearly identical. Between 20 and 50 years of age, the female-to-male ratio was nearly 3:1. Thereafter, females were admitted for asthma at a rate of about 2.5:1 when compared with their age-equivalent male counterparts. Length of stay increased proportionally as the patient age increased. After 30 years of age, the length of stay was slightly greater for females than males. There is a much higher rate of admission for prepubertal males than females. However, there is a higher incidence of asthma admissions for adult females than adult male asthmatic patients, and female asthmatic patients experience longer hospital stays per admission as well. These data indicate that adult females are more severely affected by asthma and raise the possibility that hormonal or biochemical differences related to sex may play a role in the pathophysiology of asthma.


Antidepressant medications and the relative risk of suicide attempt and suicide. Suicide by drug overdose is a major public health problem, and antidepressant medications are the most common agent involved. European studies suggest differences in the rates of suicide by overdose among antidepressants, but no reports have been published for the United States. We estimated the comparative risks of suicide attempts and suicides, and the relative risk of fatality in the event of an overdose for the major antidepressants currently marketed in the United States. Information regarding suicide attempts and suicides by antidepressant overdose was obtained from the published reports of the Drug Abuse and Warning Network and the annual report of the American Association of Poison Control Centers, and corrected for differences in total annual prescriptions using data from the National Prescription Audit. The risk of a suicide attempt did not appear to differ among antidepressants. The tricyclic antidepressants were associated with a higher rate of death in the event of an overdose than the newer nontricyclic antidepressants in both the annual report of the American Association of Poison Control Centers and the Drug Abuse and Warning Network data. The chance of death after an overdose was greater for desipramine hydrochloride than for other tricyclics. The higher risk of suicide with tricyclics vs nontricyclics may be explained by a higher rate of death from overdose rather than more suicide attempts. Tricyclics carry the risk of greater cardiotoxicity. The basis for the even higher rate of death/overdose of desipramine is not known and requires further research. If these findings are replicated in a case-control study design, they have important implications for the choice of an antidepressant for the depressed patient at risk for suicidal behavior.


Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). New definitions for sepsis and the systemic inflammatory response syndrome (SIRS) have been established. Comparatively little is known, however, about the types of patients who will be included within these new definitions. To determine what is--and what is not--known about the epidemiology and natural history of severe sepsis and SIRS. A comparative analysis of patient characteristics in the Methylprednisolone, Veterans Administration Systemic Sepsis, HA-1A, and E5 studies. At least 15% of patients in these studies had no documented infection; the proportion of all patients with severe SIRS and no documented infection is probably higher. Even among patients with presumed infection, less than half had bacteremia, and only about half had gram-negative infection or shock. The difference in the mean mortality rate of the combined studies at 14 days was 26%, while at 1 month it was 42%. Gram-negative sepsis and gram-positive sepsis seem to have similar mortality rates. Whether shock increases 30-day mortality is unclear. Patients with severe SIRS should not be assumed to have gram-negative infection; furthermore, data derived from studies of patients with gram-negative infection should be applied cautiously to all patients with SIRS. Studies of patients with sepsis or SIRS should include at least a 1-month follow-up if mortality is an end point. More consistent definitions of these disorders should permit more effective comparisons across studies.


Estimates of the number of motherless youth orphaned by AIDS in the United States. To estimate the number of youth in the United States who have been or will be left motherless by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, in order to project the need for family supports, age-appropriate foster and congregate care, and mental health and social services. Orphans are defined as youth whose mothers (the usual caregiving parent) die of HIV/AIDS-related causes. A mathematical model was constructed to estimate the number of such motherless youth. Cumulative fertility rates were applied to the number of reported AIDS deaths (1981 through 1990) and projected deaths (1991 through 1995) of adult women less than 50 years old. The results were adjusted for underreporting of HIV/AIDS-related mortality, pediatric AIDS deaths, infant mortality, ethnic and racial variation in fertility, and decreased fertility associated with late-stage HIV disease. Estimates were made for the number who were children (less than 13 years of age), adolescents (13 to 17 years of age), or young adults (18 years of age or older) at the time of their mothers' death. By the end of 1995, maternal deaths caused by the HIV/AIDS epidemic will have orphaned an estimated 24,600 children and 21,000 adolescents in the United States; unless the course of the epidemic changes dramatically, by the year 2000, the overall number of motherless children and adolescents will exceed 80,000. In 1991, an estimated 13% of US children and 9% of adolescents whose mothers died of all causes were children of women who died of HIV/AIDS-related diseases. These proportions will surpass 17% and 12%, respectively, by 1995. The vast majority of these motherless youth will come from poor communities of color. A large and rapidly growing number of American youth are being orphaned by the HIV/AIDS epidemic. Unless increased attention and resources are devoted to this vulnerable population, a social catastrophe is unavoidable.


Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. To examine the relationship between patterns of use of inhaled beclomethasone dipropionate and the risk of fatal and near-fatal asthma. Nested case-control analysis of a historical cohort; a further analysis. The 12,301 residents of Saskatchewan aged 5 to 54 years who were dispensed 10 or more asthma drugs from 1978 to 1987. The 129 persons who experienced asthma death (n = 44) and near-death (n = 85) and their 655 controls matched as to age and date of entry into the cohort, with the additional matching criteria of at least one hospitalization for asthma in the prior 2 years, region of residence, and having received social assistance. Life-threatening attacks of asthma defined as death due to asthma or the occurrence of hypercarbia, intubation, and mechanical ventilation during an acute attack of asthma. After accounting for the risk associated with use of other medications and adjustment for markers of risk of adverse events related to asthma, subjects who had been dispensed, on average, one or more metered-dose inhalers of beclomethasone per month over a 1-year period had a significantly lower risk of fatal and near-fatal asthma (odds ratio, 0.1; 95% confidence interval, 0.02 to 0.6). These data support recent guidelines from several countries that recommend the use of inhaled corticosteroids in moderate and severe asthma.


[Effects of propentofylline (HWA285) on recovery of brain function following total cerebral ischemia (TCI) in dogs]. We examined the effects of a xanthine derivative, propentofylline, on recovery of brain function following TCI in 23 adult mongrel dogs. TCI was produced by clamping ascending aorta with aortoatrial bypass formation. The dogs were divided into 3 groups: preischemic administration (0.3 mg.kg-1.min-1, 30 min), post-ischemic administration (0.5 mg.kg-1.min-1, 6h) and control. The progress of recovery of EEG, respiration, reflexes, motor functions, arousal state and behavior were observed for 7 days after TCI and the latter 5 functions were analysed using neurologic deficit score (NDS). Propentofylline shortened the time necessary for reappearance of EEG after the starting of recirculation but could not improve the NDS.


[Clinical examination of acetated Ringer solution in patients with normal liver function and those with liver dysfunction]. Acetated Ringer solution (AR) was studied clinically to find its usefulness in patients with liver dysfunction compared with lactated Ringer solution (LR). The thirty-eight patients scheduled to be operated were divided into four groups (Group I: with normal liver function and AR infused, Group II: with normal liver function and LR infused, Group III: with liver dysfunction and AR infused, Group IV: with liver dysfunction and LR infused). AR or LR was administered to each group at a speed of 10 ml.kg-1.h-1, and we investigated the differences of these four groups clinically. L-lactic acid increased significantly in all groups after administration of AR or LR. D-lactic acid increased in LR groups, and acetic acid increased in AR groups. However, the other parameters, including the acid-base balance, electrolytes and liver function, showed no significant changes in any group. Therefore the status of liver dysfunction did not affect the metabolism of lactic acid in this study. These findings indicate that as an intraoperative fluid, AR is just as useful as LR. However, there was no significant difference between the data of AR groups compared with those of LR groups. In conclusion, AR is not necessarily a better fluid compared with LR as an intraoperative fluid in patients with liver dysfunction.


[Influence of normovolemic hemodilution on organ blood flow]. The normovolemic hemodilution was carried out in adult mongrel dogs by using SALIN-HES, and organ blood flow was measured by hydrogen clearance method, and the distribution rate of cardiac output to the organ was calculated. The organ blood flow was measured in the cerebral cortex (CCBF), liver (LBF) and renal cortex (RCBF). The hematocrit level before hemodilution was 42%. The subsequent hematocrit levels (at 4 stages) were 26% at S1, 18% at S2, 10% at S3 and 5% at S4. The results suggest that higher the degree of hemodilution, CCBF increases more, and that CCBF increased significantly from S2 to S4. However, no significant variation was observed in the distribution rates of the blood flow. Moreover, no significant variation by hemodilution was also observed in both LBF and RCBF. However, a significant decrease of the distribution rate of the blood flow was observed in LBF from S1 to S2 and RCBF from S2 to S4, and the higher the degree of the hemodilution is, the rate of blood flow decreased the more remarkably.


[Coagulation changes during liver resection]. Thrombin-antithrombin III complex (TAT) and plasminogen activator inhibitor (PAI) were measured during liver resection surgery in 8 patients. TAT and PAI activities of patients under liver resection were compared with those of 11 patients under resection of esophageal carcinoma. TAT activity increased during liver resection (P < 0.001) and reached 14 times (P < 0.001) of its control value in the recovery room. PAI activity was very stable during operation, but increased to twice (P < 0.01) of its control value in the recovery room. TAT activity of patients after liver surgery in the recovery room was (P < 0.05) more than twice of that of patients after esophageal surgery. We conclude that hypercoagulable state occurred during liver resection to a greater degree compared with that observed with esophageal surgery, and that its cause might be liver resection itself.


[Effects of sevoflurane anesthesia on dopamine metabolism in the rat brain]. To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on dopamine metabolism in rat brain were studied. Sevoflurane 3% was administered for 20 minutes to Wistar male rats weighing 230-270 g under spontaneous respiration. The rats were sacrificed by decapitation and the brains were rapidly removed. They were dissected into nine discrete regions, locus coeruleus, pons plus, medulla oblongata, hypothalamus, thalamus, basal ganglia, midbrain, hippocampus, amygdala and cerebral cortex. The contents of dopamine (DA) and its major metabolites, 3, 4-dihydroxyphenyl acetic acid (DOPAC) and homovanillic acid (HVA) were measured by high performance liquid chromatography with the dual-cell coulometric detector before anesthesia, 20 minutes after the start of anesthesia and at the recovery from anesthesia. Significant increases in DA levels were observed in the pons, hypothalamus, thalamus and amygdala by sevoflurane anesthesia as compared with the control group. DOPAC levels increased significantly in the pons, hypothalamus, basal ganglia and cerebral cortex at the recovery from anesthesia. A significant increase in HVA levels was observed in amygdala by sevoflurane anesthesia, while an appreciable decrease in HVA levels was observed in hippocampus at recovery from anesthesia. It is concluded that DA metabolism is significantly suppressed in the pons, hypothalamus, thalamus, basal ganglia, midbrain and amygdala during sevoflurane anesthesia and this change in DA metabolism may be associated with the mechanism of sevoflurane anesthesia.


[Effects of sevoflurane and isoflurane on intraocular pressure in adult patients]. We investigated effects of two anesthetic agents, sevoflurane and isoflurane, on intraocular pressure (IOP). Forty adult patients were allocated randomly to two groups; Group S (sevoflurane) or Group I (isoflurane). All patients were given a bolus of thiamylal (4-5 mg.kg-1) and vecuronium (0.1-0.2 mg.kg-1) and maintained with 1-3% sevoflurane or isoflurane supplemented with nitrous oxide. Ventilation was controlled and ETCO2 was monitored. IOP, blood pressure and heart rate were measured before induction of anesthesia (control) and at the 7 points of 5, 10, 15, 30, 45, 60 and 120 minutes after intubation. In Group S, IOP was reduced significantly until 30 min compared with control IOP and the maximum decrease was 40% at 10 min. In Group I, IOP was consistently lower than control and the maximum decrease was 40% at the same time as in Group S. But there were no significant differences between the two groups at each point. It seems that the remarkable reductions of IOP after inductions are mainly caused by induction agents. In both groups, hemodynamic parameters showed no remarkable changes during maintenance. These results suggest that both sevoflurane and isoflurane are useful anesthetics for elderly patients receiving ophthalmic surgeries.


[Effects of enflurane, isoflurane, and sevoflurane on renal tubular functions]. Twenty-seven patients without renal disease were divided randomly into three groups of each nine patients. Each group received either enflurane, isoflurane or sevoflurane. The renal tubular functions were examined during anesthesia and on the first postoperative day. By inhalation of 1.49 MAC hours of enflurane, 2.17 MAC hours of isoflurane or 1.29 MAC hours of sevoflurane, creatinine clearance, Na excretion rate, urine beta 2-microglobulin and urine N-acetyl-beta-D-glucosaminidase showed no significant changes during anesthesia and the during postoperative period among anesthetic agents used. These results indicate that enflurane, isoflurane or sevoflurane does not affect renal tubular function specifically under anesthesia when each was given for less than four hours.


[Plasma catecholamine levels during air-oxygen-enflurane anesthesia compared with those during nitrous oxide-oxygen-enflurane anesthesia]. This study was designed to investigate the differences in plasma levels of epinephrine, norepinephrine and dopamine during air-oxygen-enflurane anesthesia (AOE) and those during nitrous oxide-oxygen-enflurane anesthesia (GOE). These catecholamine levels were measured at 8 carefully defined points before and during hysterectomy or ovariectomy in two groups of each ten patients. Plasma levels of epinephrine decreased significantly immediately after intubation in both groups. In the AOE group, epinephrine levels increased significantly 30 and 60 minutes after the beginning of the operation. In the GOE group, however, epinephrine levels decreased significantly 15 and 30 minutes after the beginning of the operation. The difference between the two groups was statistically significant. Plasma levels of norepinephrine increased significantly after the beginning of the operation in the GOE group but no significant differences were found in the AOE group except the levels 60 minutes after the operation. The difference between the two groups was statistically significant 15 minutes after the operation. Plasma levels of dopamine remained unchanged in the two groups. Mean arterial pressure changed with intubation and surgical stress in the two groups. The arterial pressure was significantly higher 30 minutes after the operation in the GOE group compared with AOE group. Pulse rate increased significantly during anesthesia and surgery in the GOE group. It is concluded that AOE induces more increase of plasma epinephrine and less release of plasma norepinephrine compared with GOE.


[The effect of epidural anesthesia on prostaglandin synthesis during alveolar hypoxia]. The effect of epidural anesthesia on prostaglandin synthesis during alveolar hypoxia was investigated in 20 patients. Group I received intravenous anesthesia and group II received epidural and intravenous anesthesia. Patients in both groups were intubated with a double-lumen end tracheal tube, allowing separate ventilation of the right lung with 5% CO2, 6% O2 and 89% N2 as a hypoxic challenge and the left lung with 100% O2. In both groups, adequate systemic oxygenation was maintained. Pulmonary artery pressure and pulmonary vascular resistance increased significantly in both groups. Cardiac index decreased significantly in group II. Both 6-keto PGF1 alpha and thromboxane B2 increased in group I, but only 6-keto PGF1 alpha increased in group II. Hypoxic pulmonary vasoconstriction (HPV) stimulated prostaglandin synthesis. 6-keto PGF1 alpha is the major arachidonic acid metabolite released during HPV. The results suggest that epidural anesthesia does not inhibit HPV, but exerts some effects on thromboxane B2 synthesis during alveolar hypoxia.


[Effect of halothane on the mechanical properties of rabbit right ventricular papillary muscle in the presence of either alpha or beta stimulant positive inotropic agent]. The effects of halothane (1-3 MAC) on the isometric twitch tension, the contracture tension induced by 1 mM barium (Ba2+) in the rabbit right ventricular papillary muscles, and the transient tension response to step length change during barium contracture, were analyzed in the presence of either alpha (3 x 10(-5) M phenylephrine+10(-6) M bupranolol) or beta (10(-7) M isoproterenol) stimulants. The isometric twitch tension was significantly decreased with the administration of halothane dose dependently, in the presence of both alpha or beta stimulants. Both the time to peak (TP) and the time to half relaxation (THR) were remarkably shortened with the administration of halothane in the presence of both alpha or beta stimulants. The Ba2+ contracture tension was also decreased with the administration of halothane dose dependently in the presence of both alpha or beta stimulants. The tension transient became faster with the administration of halothane in the presence of the alpha stimulant, but not in the presence of the beta stimulant. These results suggest that halothane decreases the number of active crossbridges regardless of the inotropic states induced by the two different stimulants. Also on increase the rate of crossbridge kinetics occurs in the presence of the alpha stimulant but not in response to the beta stimulant.


[Pharmacokinetics of ketamine and pentazocine during total intravenous anesthesia with droperidol, pentazocine and ketamine]. Pharmacokinetics was studied in ten surgical patients who underwent various operative procedures of about 4 hours under total intravenous anesthesia with droperidol, pentazocine and ketamine (DPK). Plasma levels of ketamine, its metabolites and pentazocine were determined thirteen times during and after DPK. During anesthesia, ketamine (KO) and norketamine (KMI) levels ranged from 0.7 to 1.0 micrograms.ml-1 and from 0.09 to 0.74 micrograms.ml-1, respectively. A small amount of dehydronorketamine (KM II) was detected only 90 min after the start of DPK anesthesia. Plasma half-lives of ketamine were calculated to be 33 min for distribution phase (alpha phase) and 60 min for elimination phase (beta phase), respectively. Pentazocine levels decreased 300 min after the induction of DPK to 10% of the control level measured 5 min after its injection. Plasma half-lives of pentazocine were 60 min for alpha phase and 140 min for beta phase, respectively. The data obtained in this clinical study show that pharmacokinetics of ketamine during DPK is almost similar to that of DFK.


[Interdependence of preload, afterload and contractility: their relation to cardiac function curve]. Formerly, the major determinants of cardiac performance, i.e., preload, afterload contractility, and heart rate had been considered independent. This individual concept of these determinants was originally advocated by E.H. Sonnenblick in 1960's, providing an extremely useful tool in understanding basic cardiac mechanical physiology. We now know, however, that these determinants of cardiac performance are, in fact, interdependent with each other both at cellular and at ventricular levels. This concept of the interdependency of the determinants, in turn, is of practical importance during the conduct of clinical anesthesia. Since we cannot isolate one determinant from the other, we have to deal with them as they are. Furthermore, monitoring a parameter of one aspects of the patient's cardiac performance is not sufficient to understand or estimate patient's status. It is necessary to integrate these informations to make clinical decision under uncertain situations.


[A patient with severe ventricular tachycardia who was saved by prolonged extracorporeal lung and heart assist]. A 47-y-o man had been suffering from cardiac failure due to refractory ventricular tachycardia (VT) after myocardial infarction. He underwent resection of the left ventricular aneurysm and cryocoagulation of the arrhythmogenic foci. On the 2nd post-operative day, VT often recurred in spite of repeated cardioversion and drug therapy, and threatened his life, even under IABP. Therefore, a veno-arterial bypass route was made and extracorporeal lung and heart assist, ECLHA, was started with a heparin bonded Maxima lung on the following day. Even under ECLHA, VT continued to recur. Cryocoagulation of the VT foci was tried again, without immediate success. A record high dose of beta-blockers, given under the circulatory support by ECLHA, stopped VT on the following day. The patient was weaned from the ECLHA circuit 12 days after the first operation, then from IABP on the 14th day. During the 10 day course of surgeries and ECLHA, the patient had almost 100 defibrillations. But for ECLHA, we may say that the patient couldn't have survived two open heart surgeries, administration of a great amount of beta-blockers, and repeated cardiac arrest without neurological sequelae.


[Anesthetic management of an infant with a single ventricle (asplenia syndrome) for non-cardiac surgery]. Ketamine and fentanyl were used for surgery of esophageal hiatus hernia in a 9 month old boy with single ventricle (asplenia syndrome). The patient was orally premedicated with diazepam 2.5 mg, and intravenously with atropine 0.04 mg. General anesthesia was induced with ketamine-fentanyl-pancuronium-100% oxygen, and maintained with fentanyl-pancuronium-100% oxygen. The total dose of ketamine or fentanyl was 0.8 mg.kg-1 or 15 micrograms.kg-1, respectively. Systolic blood pressure and heart rate of the patient were stable during ketamine-fentanyl anesthesia. Arterial oxygen saturation measured by pulse oximetry was over 90% and arterial oxygen tension was above 60 mmHg during the operation. Ketamine-fentanyl anesthesia might be useful for non-cardiac surgery of a child with cyanotic congenital heart disease.


[A case of bronchospasm during induction of isoflurane anesthesia]. Isoflurane is generally considered to prevent increase in bronchomotor tone. We report a case of bronchospasm associated with exposure to isoflurane. A 11-year-old girl was scheduled for tonsillectomy because of repeated fever. Anesthesia was induced with nitrous oxide, oxygen and sevoflurane. Sevoflurane was switched to isoflurane and increased gradually to 3%. Shortly after inhalation of isoflurane, eruption at chest appeared and auscultation of the chest revealed dry rale. Aminophylline and hydrocortisone were injected and isoflurane was discontinued. Ventilation with sevoflurane was started, but there was no improvement. Intramuscular epinephrine was given and sevoflurane was discontinued. After this, the wheezing improved. Four days later she underwent tonsillectomy under sevoflurane anesthesia uneventfully.


[A case of postoperative hepatic injury after sevoflurane anesthesia]. A 63 year old man underwent MCA aneurysmal neck clipping under O2-N2O-enflurane anesthesia. On the 46th postoperative day after the first operation, he had cranioplasty under O2-N2O-sevoflurane anesthesia. Hepatic injury occurred after the operation, and GOT, GPT and bilirubin increased above 700 IU.l-1, 800 IU.l-1 and 15.0 mg.dl-1 respectively but consciousness disturbance, hyperammonemia and DIC did not appear. His hepatic injury improved on conservative therapy. It seems that his hepatic injury was not caused by hepatitis viruses or hepatotoxicity of any drugs, but caused by cross sensitization between halogenated inhalation anesthetics, especially enflurane and sevoflurane, judging from drug induced lymphocyte stimulating test (DLST). We have to select an anesthetic method considering potential hepatic injury by halogenated anesthetics in a case of repeated anesthesia and operations during a short-term.


[The effects of pentazocine, diazepam and midazolam in patients to reduce the uncomfortable feeling during epidural block procedure]. The effects of pentazocine, diazepam and midazolam in 100 patients to reduce the uncomfortable feeling during epidural block procedure were studied. All patients (ASA I-II) were premedicated with intramuscular atropine sulfate 0.5 mg and hydroxyzine 50 mg. To relieve pain and anxiety during epidural block procedure, pentazocine (15 mg; 20 Cases or 30 mg; 20 Cases), diazepam (5 mg; 20 Cases) or midazolam (2.5 mg; 20 Cases) was given intravenously in the operating room before epidural procedure. After the epidural block, patients were anesthetized with nitrous oxide-oxygen-isoflurane or nitrous oxide-oxygen-sevoflurane. The following day, patients' self-assessments of pain during epidural block procedure were categorized as good and fair. The effects of drugs were compared between patients with im premedication only with patients with further iv administration. Patients with pentazocine 15 mg were similar to the patients given only im premedication. Pentazocine 30 mg and diazepam 5 mg tended to allay the patients' pain feeling. Midazolam 2.5 mg was effective producing anterograde amnesia and antianxiety effects. Small doses of midazolam were effective to relief patients' uncomfortable feeling.


[Polarized light irradiation near the stellate ganglion in a patient with Raynaud's sign]. Polarized light irradiation near the stellate ganglion was performed in a 55-year-old female with Raynaud's sign. She was suffering from cold and numb pain in bilateral fingers for 1 year. Stellate ganglion block and low reactive-level laser therapy near the stellate ganglion were not sufficient to relieve this symptom. Polarized light irradiation near the stellate ganglion induced a sting stimulation and warm sensation in her hands. Thermograms revealed a remarkable increase in temperature of her hands. The results imply that polarized light irradiation near the stellate ganglion increases blood flow of forearms and relieves Raynaud's sign.


[Hemodynamic management of LOS using prolonged VA bypass circulatory assist]. The authors managed five LOS patients using prolonged V-A bypass circulatory assist. Maximum CVP values were under 12 mmHg in three survivors, and 17 mmHg and 20 mmHg in two nonsurvivors. Maximum PCWP values were under 14 mmHg in survivors, and 19 mmHg and 20 mmHg in nonsurvivors. Dopamine was administrated in all cases and norepinephrine was administrated at a rate of less than 0.3 microgram.kg-1.min-1 in survivors, and in two nonsurvivors, norepinephrine was used at a rate of 0.36 and 1.2 micrograms.kg-1.min-1. Before and after disconnection of V-A bypass, the bypass flow of the three survivors were under 1.0 l.min-1 just before disconnection, and immediately after it, the preload did not increase, and the dose of administrated catecholamine increased. V-A bypass time intervals of the three survivors were 71, 42 and 87 hours, and those of the two nonsurvivors were 71 and 43 hours. Maximum bypass flow rate was above 40ml.kg-1.min-1 in four of five patients. The authors discussed the management of the patients' heart and of the V-A bypass machine during the prolonged V-A bypass circulatory assist.


[The epidemiology and clinical features of anaphylactic and anaphylactoid reactions in the perioperative period in Japan: a survey with a questionnaire of 529 hospitals approved by Japan Society of Anesthesiology]. In an attempt to review the Japanese epidemiology of the anaphylactic and/or anaphylactoid reactions in the perioperative period, we surveyed 529 hospitals approved by Japan Society of Anesthesiology with a questionnaire about drug-induced immediate adverse reactions. Recovery rate of questionnaires was 15% (80 hospitals in 529 hospitals), and 28 cases of anaphylaxis or anaphylactoid reaction were reported. Most patients were in their teens and twenties. Male were 10, and female were 12 (unknown gender; 6). Reaction occurred during the induction of anesthesia in 28.6% of the patients, and during the maintenance of anesthesia in 67.9%. Seventy-five percent of the patients had no past history of drug-induced allergy nor tendencies of atopy. Most frequent clinical signs were cardiovascular (85.7%) and cutaneous (100%) manifestations. Respiratory signs appeared in 42.9% of the patients. Patients were frequently unconscious and covered with drapes, and there is a potentially danger of masking early signs and symptoms of anaphylaxis. In most of the patients, cardiovascular collapse appeared as the first noticeable sign. Causative drugs were confirmed only immunologically in one patient. In other cases causative drugs were presumed based on clinical courses. Anaphylaxis and anaphylactoid reaction are important causes of morbidity and mortality. The incidence in Japan was 0.01% (1:10,000) and the mortality was 4.76%.


[Establishment and characterization of a new poorly differentiated gastric cancer cell line (MKK-1), derived from Borrmann type 3 tumor]. A new human gastric cancer cell line (MKK-1), derived from Borrmann type 3 tumor of the stomach, was established. It was obtained from poorly differentiated adenocarcinoma. The cell line grew in vitro, forming a sheet of monolayered cells and attaching firmly to the inner surface of culture vessels; it continued to grow for more than 1 year and 4 months. Its doubling time was 12.6 hours, with a chromosomal mode of 69. The cells could grow in nude mice; histological findings of the tumors developed in the mice showed a pattern similar to those in the primary tumor, i.e., poorly differentiated adenocarcinoma. With regards to tumor-related antigens, production of the CA19-9 was observed as time-dependent increase and was detected at a level of 4 U/ml in the culture supernatant on passage day 7, showing high values compared with the control. Immunostaining was positive for both the anti CEA antibody and the anti CA19-9 antibody. In sera examined in week 4 after subcutaneous transplantation of MKK-1 to the nude mice, CEA and CA19-9 levels were high, at 8.93 ng/ml and 44 U/ml, respectively. There was a positive correlation between increase in a tumor weight and the production of tumor-related antigens.


[Hypolactasia in Japanese Crohn's patients]. 20 g lactose load test, BHT and LTT done simultaneously were examined in 32 Crohn's disease patients and 51 healthy volunteers. Hypolactasia frequency were examined. A rise in hydrogen concentration > 20 parts per million (ppm) above the base line during breath hydrogen test and maximum blood sugar rise during lactose tolerance test were considered to indicated Hypolactasia. High rates, 50% by BHT and 72.5% by LTT, of primary adult hypolactasia were found in healthy volunteers as previously reported. Higher rates, 83.3% by BHT and by LTT (p < 0.05), were observed in Crohn's disease patients. There were higher rates in small intestine type Crohn's disease (91.6% by BHT, 92.3% by LTT) compare with healthy volunteers but no difference were found with large intestine type Crohn's disease.


[Immunohistochemical study of proliferative cells in colorectal adenoma and carcinoma]. The distribution of proliferating cells was studied in colorectal carcinoma by immunohistochemistry using monoclonal antibody-DNA polymerase alpha and Ki-67. Colorectal carcinoma was classified into two types by growth mode: (1) intramucosal polypoid growth carcinoma and (2) non-polypoid growth carcinoma. The labeling index of anti-DNA polymerase alpha and Ki-67 in non-polypoid growth carcinoma was significantly higher than in polypoid growth carcinoma. The labeling index of polypoid growth carcinoma was significantly higher than adenoma. The proliferating cells in polypoid growth carcinoma and adenoma were mainly distributed in the upper third of intramucosal neoplastic gland. However, in non-polypoid growth carcinoma, the proliferating cells of intramucosal lesion were scattered mainly in the lower third along the neoplastic gland. The distribution pattern of proliferating cells in early carcinoma with non-polypoid growth were similar to those of non-polypoid growth advanced carcinoma. These results suggested that submucosal invasion occurred more rapidly in intramucosal non-polypoid growth carcinoma.


[Purification and culture of mouse gallbladder epithelial cells in secondary culture using microexplant culture on collagen gel]. We established a new method of purification and culture of mouse gallbladder epithelial cells. In primary culture, mouse gallbladder tissue was cultured on collagen gel using microexplant culture method; the epithelial cells spread in a single sheet from the microexplant toward the periphery on the collagen gel. Tiny fragment of the collagen gel containing the border of epithelial cell layer was retransplanted onto the another collagen gel for secondary culture. This retransplantation allowed the proliferation of the epithelial cells without mesenchymal contamination, which spread on the collagen gel at the rate of 0.29 +/- 0.06 mm per day for more than two weeks. The cultured epithelial cells showed cuboid or columnar shape with focal mucus production, which is morphologically and functionally similar to the in vivo epithelial cells. This suggests that this in vitro culture method can be used to pathophysiological studies of biliary epithelial cells as well as for the method of purification of the epithelial cells.


[Five year follow-up study on dementia in institutions for the elderly]. The purpose of this study was to clarify the prognosis of senile dementia based on a 5-year follow-up study in institutions for the elderly. The subjects consisted of 747 cases over 60 years of age. Of these 316 cases showed clinical dementia but 431 cases had no intellectual disturbance in July, 1987. The mortality rate (56.3%) of the demented group was significantly higher than that (31.8%) of the non-demented group. The mortality rate of patients increased with aging. However, the mortality rate of the demented group did not correlate with the severity of dementia. An autopsy study revealed that the direct causes of death in 51.1% of demented patients were pneumonia and cardiovascular diseases. Among the demented patients followed up for 5 years, 22.5% showed severe worsening of dementia, 25.8% showed slight or moderate degree of worsening and 51.7% showed no change. Factors causing exacerbation of dementia included cerebrovascular disease and bone fracture.


[Effect of chronic smoking on regional cerebral blood flow in asymptomatic individuals]. The chronic effects of cigarette smoking upon regional cerebral blood flow (rCBF) are unclear. The present study investigated the effects of smoking on rCBF assessed by intravenous 133Xe injection in 40 asymptomatic individuals. Analysis was performed using linear regression analysis and multiple regression analysis, creating a model of the rCBF as a function of cerebrovascular risk factor. The risk factors included smoking status, smoking index, age, gender, mean arterial blood pressure, total cholesterol, fasting blood glucose, hematocrit and STT change and left ventricular hypertrophy in electrocardiogram. The male-to-female ratio was higher in the smoking group (18/2) than that in the non-smoking group (2/18). Among the smokers, mean hematocrit was significantly higher than in the non-smokers (p < 0.01). There was no significant difference in rCBF and other variables between the two groups. Linear regression analysis revealed significantly negative correlations between smoking index and CBF in the whole brain (r = -0.33; p < 0.05), right hemisphere (r = -0.34; p < 0.05), right parietal cortex (r = -0.36; p < 0.05), right occipital cortex (r = -0.34; p < 0.05) and left parietal cortex (r = -0.33; p < 0.05). In other variables, age, male sex, hematocrit, left ventricular hypertrophy and STT change showed significantly negative correlations with rCBF. To reduce the effect of confounding variables in our assessment of the dose-related response, a multivariate regression analysis was carried out treating rCBF as a dependent variable and risk factors as independent variables. In the final model, age, hematocrit, male sex and presence of BCG changes remained as independent negative predictors for rCBF.(ABSTRACT TRUNCATED AT 250 WORDS)


[An ultrasonic study of the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease in Japanese]. The study is to evaluate the relationship between extracranial carotid atherosclerosis and ischemic cerebrovascular disease using noninvasive B-mode ultrasonography and X-ray computed tomography. The sensitivity of bruits for diagnosing severe carotid stenosis was also evaluated. A total of 229 consecutive Japanese patients were recruited for this study, of which 97 had chronic-stage ischemic cerebrovascular disease and remaining 132 patients had at least one risk factor for atherosclerosis. Carotid atherosclerosis was evaluated by B-mode ultrasonography. Ischemic cerebrovascular disease was assessed by history taking, neurological findings and X-ray CT examination. The severity of carotid atherosclerosis was assessed by using two indices; plaque score and maximum percentage diameter stenosis. We also evaluated whether it was ulcerated plaque or not. Plaque score was computed by summing up all carotid plaque thicknesses (mm) on both sides. According to the CT findings, cerebral infarction was divided into two types; deep subcortical infarction and cortical infarction. The incidence of cerebral infarction increased in relation to plaque score and maximum percentage stenosis. Although the incidence of cerebral infarction in patients without carotid atherosclerosis was only 33% (38/116), it in patients with moderate carotid atherosclerosis (plaque score > 5) was 59% (26/44) (p < 0.05, chi-square test). The incidence of ipsilateral infarction was revealed to be higher in patients with severe (50% or more) carotid stenosis (61%) than in cases of mild stenosis (28%) (p < 0.05). Thirteen patients had ulcerated plaques and they suffered more frequently cerebral infarction than patients without ulcerated lesions. Cortical infarction was more frequent in patients with severe carotid stenosis than in patients without carotid atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)


[Clinicopathological study of autopsy cases of pancreatic carcinoma in the elderly]. A total of 257 autopsy cases of pancreatic carcinoma, including 160 male and 97 female cases with an average age of 68.2 years, were divided into an aged group (70 years or older, 136 cases) and a control group (younger than 70 years, 121 cases), and their respective clinicopathological features were compared. The male to female ratio was 1.2:1 in the aged group and 2.6:1 in the control group. In both groups, abdominal pain was noted in about one-third of the cases as the primary symptom, followed by appetite loss and icterus. Concerning the primary symptoms, the two groups did not differ from each other. The rate of surgical resection was higher in the control group (24.0%) than the aged group (10.3%). Mean survival times were similar in both groups (5.71 months for the aged group and 6.01 for the control group). Intrapancreatic location of the tumor showed similar tendencies in both groups. However, cancer of the head of the pancreas was 2.3 times more common than body/tail cancer in cases aged 80 or more. Approximately 90% of the cases were diagnosed as ductal carcinoma by histological examination. The degree of differentiation was similar in both groups, but the well differentiated type was somewhat predominant in cases 80 years or older. Metastasis or direct invasion was noted to the liver, peritoneum and lung in this order in both groups. Liver and lymph node metastasis were less frequent in cases 80 years or older. Multiple primary cancers were noted in 8.8% of the aged group and 9.1% of the control.(ABSTRACT TRUNCATED AT 250 WORDS)


[Quality of the life in hypertensive outpatients]. In order to evaluate the quality of life (QOL) in hypertensive outpatients, we selected 78 patients with hypertension of various degrees of severity (WHO Classification I: 29 cases, II: 15, III: 34), 59 not ill healthy persons (N1) and 22 normotensive outpatients (N2) aged at 50 years and over, using the self-completed questionnaire (QUIK) which we developed. QUIK covers four domains including physical functioning (20 questions), emotional adjustment (10), interpersonal relationships (10) and attitudes toward life (10) totaling 50 questions. In this study the internal consistency of QUIK was alpha = 0.95 by the Kuder-Richardson formula 20 and it's repeatability was r = 0.89 by the Spearman-Brown formula. The QOL in hypertensive outpatients was definitely worse in terms of total score (N1 5.1 +/- 4.4 vs WHO II 9.3 +/- 7.2 and III 12.1 +/- 5.6, p < 0.05), for physical functioning (N1 2.5 +/- 2.1 vs WHO I 3.7 +/- 2.8, II 4.7 +/- 3.8, III 5.4 +/- 2.8 p < 0.05), for emotional adjustment (N1 1.2 +/- 1.4 vs WHO III 2.3 +/- 1.7, p < 0.01), for interpersonal relationships (N1 0.8 +/- 1.3 vs WHO III 1.6 +/- 1.5, p < 0.01) and for attitudes toward life (N1 0.7 +/- 1.2 vs WHO III 2.7 +/- 2.0 p < 0.01). The total QUIK score increased according to the severity of symptoms (WHO I 5.8 +/- 4.4, WHO II 9.3 +/- 7.2 and WHO III 12.1 +/- 5.6), respectively. The total score of WHO I was significantly lower compared with that of WHO III (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


[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)


[EEG findings in hip fracture of the elderly]. Twenty three patients with hip fractures, over 70 years old of age, who had surgical treatment and medical rehabilitation in the Yokufukai Geriatric Hospital were studied to evaluate changes of EEG findings at the time of hip fracture. In all cases, the pre-fracture ambulation status were independent. EEG findings were graded as normal, abnormal (minor degree, moderate-to-severe degree) and states of ambulation after hip fracture were graded good or poor. Good ambulation was defined as total independence and poor ambulation was defined as dependent on assistance or bedridden. In 11 cases of good ambulation, nine had an EEG which was normal or abnormal to a minor degree during pre- and post-fracture periods. In 12 cases of poor ambulation, seven had an EEG which was normal or abnormal to a minor degree in the pre-fracture period, but in the post-fracture period, only two of them were in the same grade and five showed moderate-to-severe abnormal EEG findings. Five out of 12 cases of poor ambulation demonstrated moderate-to-severe EEG abnormality in pre- and post-fracture periods. The present study suggests that the response to hip fractures in the elderly are divided into two types based on their brain functions. One group can maintain good brain function immediately after hip fractures, while the other can not maintain sufficient brain function and lose their ambulatory ability.


[A study on 24-hour ambulatory blood pressure in normotensive elderly, living in a local home for the aged]. Ambulatory blood pressure (BP) was non-invasively monitored in 124 normotensive elderly, living in an old people's home at the annual health examination. Cases were divided into 41 cases < 75 years (group A, mean age 70.6) and 83 cases > or = 75 years (group B, 82.7) for analysis of the office BP and 24-hour BP. Whole-day systolic BP in group B was significantly higher than those in the group A (p < 0.02) although no significant differences were observed in diastolic BP and pulse rate. Separated analysis of whole-day BP into daytime and nighttime revealed that the nighttime systolic BP in the group B was significantly higher than those in group A (132.2 +/- 17.4% vs. 123.8 +/- 18.6 mmHg, p < 0.02) whereas no significant difference was observed in day-time systolic BP between two groups (136.6 +/- 14.9 vs. 132.1 +/- 14.4 mmHg, n.s.). The day-night difference in systolic BP tended to be less in group B than in group A (4.5 +/- 11.6 vs. 8.2 +/- 12.2 mmHg, p < 0.10). The prevalence of non-dippers, who had a higher nighttime systolic BP than daytime systolic BP were 24.4% of the group A and 30.1% of the group B. It was concluded that systolic BP during the nighttime increased with the ageing process after age 60, although that during daytime did not change.


[Serum alpha 1-antichymotrypsin in senile dementia]. To evaluate the clinical significance of serum alpha 1-Antichymotrypsin (ACT) as an early diagnostic marker of senile dementia of Alzheimer type (SDAT), we measured 333 healthy and not demented elderly subjects, 27 cases SDAT and 25 cases of vascular dementia (VD). For the measurement, a new high-sensitivity method, double antibody radioimmunoassay method was developed. In healthy elderly subjects, the mean value of serum ACT was 0.229 mg/ml. A tendency towards increase of ACT with aging was noted but was not significant. The serum level of ACT in the SDAT patients was significantly higher (0.309 mg/ml) compared with the healthy elderly subjects and the VD patients (0.226 mg/ml) (p < 0.01). We concluded that in the patients with SDAT, there was an overproduction of ACT and the serum value of ACT was markedly elevated. The measurement of serum ACT is very useful (sensitivity = 88.9%, specificity = 68.7%; cut-off value = 0.250 mg/ml) for the early differential diagnosis of senile dementia.


[A study of factors affecting the concentration of serum lipid peroxide in the elderly inhabitants in a rural area]. Among 16 male (mean age of 66.6 years) and 51 female (mean age of 65.3 years) inhabitants of a rural area, the concentration of serum lipid peroxide measured as malondialdehyde (MDA) by Yagi's method was analyzed by physicochemical and food intake items. The MDA level in serum showed a peak of 6.2 nmol/ml at fifties years old in females and showed constant values of 4.6 and 6.1 nmol/ml for females and males, respectively, in those aged 60 more. The MDA level significantly correlated positively to total- or LDL-cholesterol level and urinary K/Cr, thus MDA level seemed to be a risk factor of arteriosclerosis. Fruit intake significantly positively correlated to MDA level in male. The MDA level showed a significantly higher level in the group with both higher total-cholesterol and urinary K/Cr levels, than in the other groups. It is suggested that a high intake of potassium increases the MDA level in the group with higher total-cholesterol level.


[A case of "pure" progressive autonomic failure in an elderly male]. A 68-year-old man was admitted to our hospital because of postural hypotension in July 1991. He was also suffering from anhydrosis, urinary disturbances, constipation and impotence. He had not developed signs of Parkinsonism, cerebellar or peripheral neuropathy four years from the onset. Various autonomic function tests showed sympathetic and parasympathetic dysfunction of mainly postganglionic origins. Thus we diagnosed this patient as "pure" progressive autonomic failure ("pure" PAF). "Pure" PAF is a new entity described by Bannister and Oppenheimer in 1982. It shows symptoms of autonomic failure without other neurological disturbances which manifest as Shy-Drager syndrome. Treatment with L-DOPS increased his blood pressure level and attenuated his symptoms due to orthostatic hypotension.


[Effects of night shift on plasma concentrations of melatonin, LH, FSH and prolactin, and menstrual irregularity]. To examine the effect of night shift on the ovarian function, 122 teachers, 67 office workers, 377 nurses, 133 factory workers and 67 barmaids were surveyed. The incidence of irregular menstrual cycle was 13.1% in teachers, 14.9% in office workers, 24.9% in nurses, 36.8% in factory workers and 40.3% in barmaids. The incidence was significantly higher in women working at night than women working during the day. Plasma concentrations of melatonin, LH, FSH and prolactin were determined at 2200 h and 0200 h in 5 nurses working at night and in 6 nurses resting in their quarters. Plasma concentrations of melatonin and prolactin at 0200 h were significantly lower in nurses of the working group than others of the resting group, but plasma concentrations of LH and FSH did not differ between the two groups. These results indicate that night shift suppresses the ovarian function by affecting the circadian rhythm of melatonin and prolactin.


[A 4 degrees C-1 min method of cold water immersion test for peripheral circulatory function in fingers]. To assess the validity of a new simplified cold water immersion test (4 degrees C-1 min method) for peripheral circulatory function, comparison was made with the conventional method (10 degrees C-10 min method). These two different methods of cold immersion test were applied to 23 patients with vibration disease and 24 healthy men. Observation was made on finger skin temperature by a thermistor and complaints in the hand by a 5-step self-reported scale method every minute during the test. The patterns of recovery of skin temperature after cold immersion in each group were similar in both methods. Pain in the hand in the 4 degrees C-1 min method was less than that in the 10 degrees C-10 min method. The recovery rate at 5 min in the patients with Raynaud's phenomenon was lower than that in those without Raynaud's phenomenon in the 4 degrees C-1 min method (p < 0.01). However, no significant differences were noted in 10 degrees C-10 min method. The results suggest that the new method is feasible in detecting the response of vasodilation after immersion. In the recovery rate at 5 min after immersion, near values of the sensitivity and specificity were observed between 50% cut-off values in the 4 degrees C-1 min method and 30% value in the 10 degrees C-10 min method. Thus, the 4 degrees C-1 min method is considered to be more useful to evaluate the physiological response after cold immersion than the 10 degrees C-10 min method.


Can death at a low COHb concentration frequently observed in fire victims be explained by hypoxic hypoxia? Fire deaths at low COHb (carboxyhemoglobin) concentrations are frequently observed, but it is difficult to determine the causative factors. Participation of hypoxic hypoxia was examined using rats and rabbits exposed to various low-O2 and CO gas mixtures. The ranges of O2 and CO concentration were 3.0-22.2% and 0.3-2.9%, respectively. The concentration of CO2 was fixed at about 5%. Rats were individually exposed to the test gas in a plastic chamber. Rabbits inhaled the test gas through a tracheal cannula. The survival time of rats ranged from 3.9-7.7 min, and that of rabbits was 8.0-22.5 min. Rats exposed to the most hypoxic gas mixture (O2 3%-CO 0.3%) died with COHb values below 40%. Rabbits also died with a low COHb concentration under this condition, but the COHb concentration was not below 50%. Rabbits were considered to be more resistant to hypoxic hypoxia than rats. From the literature on the relationship between the grade of burns and the concentration of COHb, as well as the findings obtained in the present experiment, hypoxic hypoxia did not appear to be a main factor causing death at low COHb concentrations. In the rabbit the COHb concentration increased exponentially and reached plateau levels within 10 min in many groups. The time required to reach a plateau COHb level was shorter when the concentration of CO was high and that of O2 was low.


Postmortem changes of triazolam concentrations in body tissues. Postmortem changes of triazolam concentrations in body tissues were examined using rats, in order to find the most suitable tissue samples for toxicological analysis. Triazolam was orally given to rats (5 mg/kg), and then the rats were sacrificed 1 hour after administration. Tissue samples were collected 0, 1 and 2 days after storage at 22-24 degrees C, and the triazolam concentration in each sample was measured using gas chromatography with a nitrogen phosphorus detector. Triazolam concentrations were markedly increased in the spleen, the abdominal muscle, the liver and the kidney, and were slightly increased in the blood and the lung. On the other hand, no changes were observed in the thigh muscle or the brain, and the value in the thigh muscle was similar to those in the blood samples collected immediately after death. The results indicate that triazolam diffuses into the surrounding tissues through the stomach wall after death, so that the thigh muscle and the brain have to be analyzed as well as the blood for a correct diagnosis of triazolam ingestion.


VNTR polymorphism of the collagen type II, alpha 1 (COL2A1) gene detected by PCR. The 3' side of the human type II collagen alpha 1 (COL2A1) gene contains a region consisting of a variable number of tandemly repeated short A + T-rich DNA sequences (VNTR). We amplified this region accurately by the polymerase chain reaction (PCR). Genomic DNA was purified from isolated buffy-coat cells, and thermostable Taq polymerase was used to amplify the target region. The amplification products were directly visualized after polyacrylamide gel electrophoresis. In this way, five alleles were distinguished in chromosomes from 33 unrelated Japanese, and named A, B, C, D, and E in decreasing order of length. The relative frequencies of the COL2A1 3' VNTR alleles A through E were 0.045, 0.075, 0.469, 0.015, and 0.393, respectively. Co-dominant segregation was observed in two informative families. The COLA2A1 3' VNTR locus was estimated to have a heterozygosity index of 62% and a polymorphic information content of 0.55.


Serological and biochemical studies on En(a-) human erythrocytes in a Japanese family. The propositus erythrocytes with phenotype En(a-), which was found in the first example of a Japanese family, reacted with anti-N serum weaker than the ordinary phenotype N erythrocytes. When the erythrocyte membranes of the propositus were subjected to SDS-PAGE, no glycophorin A was observed on the gel by PAS staining, whereas glycophorin B band was observed. The S and the s antigens of the propositus erythrocytes were appeared to be normal. These results suggested that N activity of the propositus erythrocytes may be derived from glycophorin B components on the erythrocyte membranes. The amounts of bound sialic acid of the erythrocyte membranes were significantly lower in the En(a-) erythrocytes than the ordinary OMN erythrocytes. Neither the OMN nor the En(a-) erythrocytes showed the agglutinability to Arachis hypogaea lectin. The number of lectin receptor sites on the En(a-) erythrocyte membranes was significantly lower than on the OMN erythrocyte membranes for Limulus polyphemus, Triticum vurgaris and Bauhinia purpurea lectins. These results provide further support for the contention that En(a-) cells lack the glycophorin A as major erythrocytes sialoglycoprotein on the membranes.


A fatal case of a single stab wound penetrating the small, narrow atlantoaxial interspace. A 73-year-old woman was found dead with a small wound on the nape of her neck. The wound was oval in shape, measuring about 0.6 cm in length along the major axis, with a slightly irregular margin. The wound injured the medulla oblongata through the atlantoaxial interspace, and reached the left vertebral artery. This wound was found to be the cause of death. The wound depth was 5 cm in length, with the direction of the wound canal from posterior-lower right to anterior-upper left. The size and appearance of the wound corresponded to those of the horizontal section of a skewer used by the assailant. Such a fatal case due to a single stabbing of the medullar oblongata by the chance gliding of a skewer through the small, narrow atlantoaxial interspace is considered to be exceptional.


[Presence of a PCR-inhibitor in hairs].

[Presence of a PCR-inhibitor in hairs]. A polymerase chain reaction (PCR) system was used to amplify the noncoding 333-bp region of mitochondrial DNA (mt333DNA) contained in DNA extracts from single human hairs, and the following results were obtained: 1) Using natural black hairs, mt333 DNA was always amplified from a 5-cm length of hair shaft sampled within a region 11 cm from the hair root, but it was not always amplified from a 5-cm region adjacent to this 11-cm region, and was not amplified in almost all cases when a 5-cm length of hair shaft was sampled from a region more than 16 cm distant from the hair root. DNA preparations not responding to PCR were colored dark brown. 2) Using natural white hairs, mt333DNA was amplified from almost all specimens even up to a length of 31 cm. 3) When natural black hairs were stained with an oxidation-type hair-staining agent (Bigen-5Ge), mt333DNA was never amplified even from the hair root portion, whereas the same staining treatment of white hairs did not influence the amplification of mt333DNA. In the cases showing no response on PCR, DNA preparations were also colored dark brown. 4) These dark brown DNA preparations inhibited completely the amplification of mt333DNA even after addition of purified DNAs. These results suggest that the dark brown substance in the DNA preparations inhibits the amplification of mt333DNA by the PCR method. We therefore investigated the mechanism responsible for the development of this inhibitor. It was found that hydrogen peroxide (a component of hair-staining agent) induced formation of water-soluble melanins from insoluble melanins.(ABSTRACT TRUNCATED AT 250 WORDS)


[Asphyxial death by laryngopharyngeal tumor--two autopsy cases]. Case 1. A 44-year-old male died about 3 h after paracenteses of both palatine tonsils. A 6.5 x 2.5 x 2.0 cm tumor, caused by bleeding and edema, was revealed at medico-legal autopsy. This tumor extended from the right palatine tonsil to the right edge of epiglottis. The cause of death was determined to be acute asphyxia due to the obstruction of the airway by the tumor. Case 2. A 51-year-old female was thought to have been killed by manual strangulation. At medico-legal autopsy, three malignant tumors, each of which was not as large as the tip of the little finger, were found in the lower pharynx. There were no findings of acute asphyxia death. The cause of death was determined to be delayed asphyxia caused by the malignant tumors.


[Fracture of the cervical spine caused by blow in patient with ankylosing spondylitis--a report of an autopsy case]. Fracture of the cervical spine in a patient with ankylosing spondylitis is presented. A 43-year-old male was involved in a fight when drinking. He received blows to his face and the lower jaw, and fell backward on the street and died. The postmortem examination showed abrasions and subcutaneous hemorrhages on the face and the lower jaw. A transverse fracture was observed through the intervertebral disc space between the fifth and sixth cervical vertebrae. The cervical spinal cord was completely ruptured at the fracture site. Ossification of the supporting ligaments and anterior surface of dics were found. The spine was bony ankylosed. The alcohol levels of blood and urine were 2.95 and 3.84 mg/ml, respectively. The cause of death was paralysis of respiration. The victim had suffered from the ankylosing spondylitis for many years. His neck had no mobility. The X-ray films taken at age 42 showed complete ankylosis of the spine, so-called "bamboo" spine. It seemed that the blow to his face and the lower jaw caused hyperextension of the neck and easily caused the cervical fracture because of the loss of flexibility and fragility from osteoporosis in the ankylosed spine.


[An autopsy case of fatal nicotine poisoning]. A fatal case of nicotine poisoning is reported in which a 44-year-old female committed suicide in a short time by taking orally the eluate from tobacco. External examination showed no abnormal findings except for markedly dark red-purple postmortem lividity, and internal examination demonstrated no pathological changes but the signs of sudden death. Through the toxicological investigation by GC and GC-MS, however, nicotine was detected in the solution which she had taken orally and in the blood, urine and the contents of the stomach and small intestine. The nicotine concentrations of the blood, urine and contents of stomach and small intestine were 6.3 micrograms/ml, 1.5 micrograms/ml, 30 micrograms/ml and 71 micrograms/g respectively, and enough to be lethal.


MCI-826 is a potent and selective antagonist of peptide leukotrienes (p-LTs) and has characteristics distinctive from those of FPL 55712. Antagonistic effects of a newly synthesized compound, (E)-2,2-diethyl-3'-[2-[2-(4-isopropyl)thiazolyl]ethenyl]succinanilic+ ++ acid sodium salt (MCI-826) on the contraction of the isolated guinea pig trachea and human bronchus induced by various agonists including peptide leukotrienes (p-LTs), histamine, acetylcholine (ACh), prostaglandin (PG) D2 and others were investigated and compared with the effects of a p-LT antagonist, FPL 55712, in some experiments. MCI-826 potently antagonized LTD4- and LTE4-induced contractions at extremely low concentrations in the isolated guinea pig trachea with pA2 values of 8.3 and 8.9, respectively, on a molar basis. These values indicated that MCI-826 is over 100 times stronger than FPL 55712. Similarly, MCI-826 at 10(-8) g/ml (2.4 x 10(-8) M) markedly antagonized LTD4-induced contractions of the isolated human bronchus. Although FPL 55712 fairly inhibited the 10(-9) g/ml LTC4-induced contraction of the isolated guinea pig trachea, MCI-826 had little effect on the contraction at high concentrations like 3 x 10(-6) g/ml (7.1 x 10(-6) M). MCI-826 modestly affected the other agonist-induced contractions and the resting tonus of the isolated guinea pig trachea at 10(-6) g/ml (2.4 x 10(-6) M) or higher concentrations, but FPL 55712 caused fair inhibition of some of those contractions and gradually lowered the resting tonus with time. These results indicate that MCI-826 is a highly potent and selective antagonist of LTD4 and LTE4 and can be a useful tool for biological and pharmacological experiments on p-LTs.


Different modes of potentiation by beta-eudesmol, a main compound from Atractylodes lancea, depending on neuromuscular blocking actions of p-phenylene-polymethylene bis-ammonium derivatives in isolated phrenic nerve-diaphragm muscles of normal and alloxan-diabetic mice. The essential moieties in p-phenylene-polymethylene bis-ammonium (PMBA) derivatives, C6H4[X(CH2)nN+R3]2, on the potentiating effects by beta-eudesmol, a main component of Atractylodes lancea, of their neuromuscular blockades were investigated in isolated phrenic nerve-diaphragm muscle preparations of normal and alloxan-diabetic mice. PMBA derivatives were separated into the following three groups based on the patterns of the potentiating effects: group I: PMBA-23 (n = 6, R = Me) and PMBA-24 (n = 6, R = Et); group II: PMBA-1 (n = 4, R = Me), PMBA-21 (n = 4, R = Et) and PMBA-2 (X = O, n = 3, R = Me); and group III: PMBA-31 (X = S, n = 3, R = Me), PMBA-3 (X = CO, n = 3, R = Me) and PMBA-4 (X = CHOH, n = 3, R = Me). The pretreatment with 80 microM beta-eudesmol for 60 min did not affect group I-induced neuromuscular blocking action, and it potentiated group II- and group III-induced ones. The potentiating effect of beta-eudesmol on group III was greater in diabetic muscles than in normal one and that on group II was to the same extent in both muscles. These results suggest that the four-methylene length of the side chains in normal muscles and the hydrophilic moieties adjacent to a phenylene ring in diabetic muscles are related to the potentiating effect by beta-eudesmol on PMBA derivatives.


Cetraxate improves ethanol-induced gastric mucosal congestion in anesthetized dogs. Gastric mucosal microcirculatory disturbance in experimental animals is stressed as an important factor in the development of gastric ulceration induced by ethanol. In this study, we used a reflectance spectrophotometry system to investigate the effect of cetraxate on ethanol-induced gastric mucosal hemodynamics in anesthetized dogs. Forty percent ethanol caused a significant increase in the mucosal blood volume and a significant decrease in mucosal hemoglobin oxygenation. The changes in these parameters indicated mucosal congestion and tissue hypoxia. Topical administration of cetraxate (200 mg in 10 ml saline) prevented the increase in mucosal blood volume and decrease in mucosal hemoglobin oxygenation which had been induced by ethanol loading in the stomach. In conclusion, cetraxate showed a protective effect on mucosal microcirculation that resulted in the maintenance of the gastric mucosal integrity against ethanol loading in the gastric mucosa.


Assessment of the ambulation-increasing effect of ketamine by coadministration with central-acting drugs in mice. The coadministration of ketamine (12.5 mg/kg, but not 3.1 mg/kg, s.c.) with methamphetamine (2 mg/kg, s.c.), cocaine (10 mg/kg, s.c.), scopolamine (0.5 mg/kg, s.c.), caffeine (10 mg/kg, s.c.) and MK-801 (0.1 mg/kg, i.p.) significantly enhanced the ambulation-increasing effects. Furthermore, in the coadministration with morphine (10 mg/kg, s.c.) and GBR-12909 (10 mg/kg, i.p.), not only 12.5 mg/kg but also 3.1 mg/kg of ketamine produced a significant enhancement. On the other hand, the ambulation-increasing effect of ketamine (12.5 mg/kg, s.c.) was significantly suppressed by ceruletide (0.01 mg/kg, i.p.), alpha-methyl-p-tyrosine (100 and 300 mg/kg, i.p. x 2), nimodipine (1 and 3 mg/kg, i.p.), haloperidol (0.03 and 0.1 mg/kg, s.c.), a low dose of apomorphine (0.1 mg/kg, s.c.), physostigmine (0.1 mg/kg, s.c.) and N6-(L-2-phenylisopropyl)-adenosine (0.1 mg/kg, s.c.). However, imipramine (20 mg/kg, i.p.), 6R-L-erythro-5,6,7,8-tetrahydrobiopterin (100 mg/kg, s.c.), a high dose of apomorphine (0.5 mg/kg), reserpine (0.3 and 1 mg/kg, s.c.), propranolol (0.3 and 1 mg/kg, s.c.), phenoxybenzamine (3 and 10 mg/kg, s.c.) and naloxone (0.3 and 1 mg/kg, s.c.) scarcely interacted with ketamine. These results suggest that ketamine increases the ambulatory activity in mice by facilitating dopamine release from a newly synthesized pool at the presynaptic level, which is affected by a calcium-dependent mechanism.


Induction of gastric lesions by 2-deoxy-D-glucose in rats following chemical ablation of capsaicin-sensitive sensory neurons. Effects of chemical ablation of capsaicin-sensitive sensory nerves on functional and mucosal ulcerogenic responses to 2-deoxy-D-glucose (2DG) were investigated in the rat stomach, in comparison with those of indomethacin, a prostaglandin (PG) biosynthesis inhibitor. Intravenous injection of 2DG (200 mg/kg) followed by infusion of this agent (100 mg/kg/hr, i.v.) significantly increased gastric acid secretion and motility, but rarely induced macroscopic damage in the gastric mucosa of normal conscious rats. Chemical ablation of capsaicin-sensitive sensory nerves or pretreatment with indomethacin (5 mg/kg, s.c.) did not significantly affect the acid secretory and motility responses to 2DG, but induced severe hemorrhagic lesions in the stomach within 4 hr. Gastric mucosal blood flow (GMBF) determined by laser Doppler flowmetry under anesthetized conditions did not consistently change during 2DG treatment in any of these three groups, but the rise in GMBF in response to mucosal acidification (0.2 N HCl) was significantly inhibited in the animals pretreated with indomethacin or following chemical deafferentation. We conclude that functional ablation of capsaicin-sensitive sensory neurons, similar to the PG deficiency, increases the gastric mucosal vulnerability during 2DG infusion (acid hypersecretion and hypermotility due to vagal excitation), resulting in hemorrhagic lesions, and that the mechanism may be accounted for at least partly by the impairment of gastric mucosal blood flow response to mucosal acidification.


Beta-phenyl-beta-alanine prevents the activation of vagal efferent discharges evoked by baclofen and GABA in rats. The effects of DL-beta-phenyl-beta-alanine (BPBA) on vagal efferent discharges elicited by gamma-aminobutyric acid (GABA) and baclofen were investigated in rats. When given alone, BPBA (40 mg/kg, i.v.) caused no significant change in vagal nerve response and did not elicit any convulsions. Pretreatment with BPBA (40 mg/kg, i.v.) resulted in 70% and 80% reductions in the vagal efferent discharges induced by GABA (400 mg/kg, i.v.) and baclofen (4 mg/kg, s.c.), respectively. The present results suggest that BPBA may be a novel GABA antagonist with respect to vagal activation mechanisms in the CNS.


Cerebrovascular injuries induced by activation of platelets and leukocytes in vivo and their correction by neurotropin. Ischemia-like brain damage was induced in cats by selective injection of 4 beta-phorbol-12 beta-myristate-13 alpha-acetate (PMA) into the left carotid artery. PMA-injection provoked significant decreases in platelet and neutrophil counts due to their intravascular aggregation. Platelet and neutrophil aggregates caused brain edema with accumulation of sodium fluorescein in the cerebrospinal fluid and ipsilateral derangement of the cerebral energy state in the parietal cortex. Neurotropin administration decreased the changes in platelet and neutrophil counts and prevented the developments of both brain edema and cerebral energy failure.


Inhibitory effects of magnoshinin and magnosalin, compounds from "Shin-i" (Flos magnoliae), on the competence and progression phases in proliferation of subcultured rat aortic endothelial cells. Anti-proliferative effects of magnoshinin and magnosalin derived from "Shin-i" (Flos magnoliae) were investigated using subcultured endothelial cells (EC) of rat aorta. The inhibitory effects of magnoshinin were 2-fold greater at 10 micrograms/ml than that of magnosalin on the increase in cell number when EC were stimulated by 5% fetal bovine serum. In the 3H-thymidine incorporation monitored at 3 hr-intervals, magnoshinin (0.1-3 micrograms/ml) prolonged the starting time of DNA synthesis and reduced the rate of incorporation into EC. Magnosalin (0.3-3 micrograms/ml) reduced only the incorporation rate. These results suggest that magnoshinin inhibits both the competence phase and progression phase, but magnosalin preferentially inhibits the progression phase in EC proliferation.


Protection by halothane of the vagal baroreflex system from transient global cerebral ischemia in dogs. A possible cerebroprotective effect of halothane was investigated in a canine model of 5-min global cerebral ischemia. In pentobarbital-anesthetized dogs, additional inhalation of 0.5 to 1% halothane prior to ischemia prevented the post-ischemic dysfunction of the vagal component of reflex bradycardia. In contrast, pretreatment with thiopental at 10 mg/kg, i.v. failed to prevent it. The influence of ischemia in the absence of anesthetics was similar to that under barbiturate anesthesia. The results suggest that halothane, but not barbiturate, may actively protect the vagal baroreflex system from ischemia.


Anthralin, a non-TPA type tumor promoter, synergistically enhances phorbol ester-caused prostaglandin E2 release from primary cultured mouse epidermal cells. Primary cultures of mouse epidermal cells (i.e., target cells of skin tumor promotion) stimulated by 12-O-tetradecanoylphorbol-13-acetate (TPA) release prostaglandin E2 within 30 min. Anthralin, a non-TPA type tumor promoter, also stimulated PGE2 release; however, no release was detectable at least up to 4 hr after the addition of anthralin. When the cells were incubated with TPA plus anthralin, both PGE2 and arachidonic acid release were synergistically enhanced. Other non-TPA type tumor promoters, i.e., chrysarobin, 7-bromomethylbenz[a]anthracene, benzoylperoxide, okadaic acid and palytoxin, did not potentiate the TPA-caused PGE2 release. In protein kinase C-down regulated cells, the synergistic stimulation of PGE2 and arachidonic acid release by TPA plus anthralin were not detected. Anthralin plus TPA did not alter the incorporation of arachidonic acid into cellular phospholipids. Cellular cyclooxygenase activity was increased 2 hr after TPA stimulation. Anthralin-caused increase in cyclooxygenase activity was detected at 6 hr after the addition of anthralin. Cyclooxygenase activity was synergistically increased by treating the cells with TPA plus anthralin. Cycloheximide and actinomycin D inhibited the increase in cyclooxygenase activity caused by anthralin or TPA plus anthralin. These results indicate that anthralin synergistically stimulates TPA-caused PGE2 release by synergistically increasing arachidonic acid release and cellular cyclooxygenase activity.


[Diagnosis and therapeutic tactics in polycystic liver]. The results of clinical observations of 60 patients with polycystosis of the liver who had been treated or examined by the authors in the period from 1964 to 1989 were summarized. The clinical course of the disease was featured by scanty clinical signs: pains in the upper half of the belly and hepatomegaly were most frequent. The combination of diagnostic techniques for verification of surgical intervention necessity was established. Besides, it was stated that the diagnosis of polycystosis of the liver should be complex and based on anamnestic data and the results of clinical, laboratory and instrumental investigations. Preference should be given to ultrasonography and computed tomography. Cysts with diameter of 5 cm and more, complicated polycystosis of the liver (bleeding, suppuration, malignancy) and cystic compression of the extrahepatic bile ducts and vessels (portal and cava inferior veins) were found to be indicative signs for surgical treatment of hepatic polycystosis. A total of 41 patients were subjected to surgical treatment with 49 operational procedures employed. Fenestration of hepatic cysts (42), that were organosparing operations, predominated. Resection of the liver was performed in 2 patients who had total cyst substitution for the whole of the left lobe. The improvement registered in 85.7% of operated on patients evidenced the favorable results of surgical treatment.


[Indicators of the lithogenic properties of the bile: methods of their evaluation, clinical availability and informative value]. Duodenal bile taken by gastroduodenal intubation of patients with chronic calculous cholecystitis with intact gallbladder performance was investigated as was the bile taken in those with chronic acalculous cholecystitis or in those without clinical signs of cholecystitis and concurrent diseases. The bile was investigated for cholesterol, bile acids and lecithin levels. All the parameters obtained were used for computation of lithogeny parameters: Swell, Admirand-Small, Metzger, Thomas, Andrews and cholesterol-lecithin ratio. The study performed indicated that Swell's parameters of lithogeny and cholesterol-lecithin ratio displayed more precisely lithogeny of the bile, and could be determined more easily than other parameters.


[Clinical value of determining serum levels of glycocholic acid in alcoholic lesions of the liver]. To assess the diagnostic value of radioimmunoassay determination of serum levels of glycocholic acid in alcohol-induced chronic diffuse hepatic lesions, this technique was compared by sensitivity and informative content with conventional hepatic tests. Hepatocytic function was measured in combined examination of 83 patients and 30 controls. It is shown that serum glycocholic acid concentration permits detection of early alcohol defects of the liver, excretory dysfunction in particular, control of cholestatic changes, of transformation of hepatic steatosis into hepatitis or cirrhosis, evaluation of cholestasis. The above radioimmunoassay is a useful prognostic tool in decompensated alcohol cirrhosis of the liver.


[Ultrasonographic diagnosis of tumors of the gallbladder]. The role of echography in the diagnosis of gallbladder tumors was investigated. Benign tumors (papilloma and adenoma) were diagnosed in 2 patients and carcinoma in 18 subjects. This technique failed to diagnose carcinoma in 2 patients. Two more procedures had false-positive results (in one patient multiple clots in the dramatically enlarged bladder were taken for the tumor while ++post-inflammatory granulation in the other patient was mistaken for the tumor as well). Echographical signs of gallbladder tumors were presented, as were the criteria permitting one to differentiate carcinoma from other pathological formations in the gallbladder (echogenic bile, cholesterol polyps, cholecystitis, adenomyomatosis). High informative value of echographic investigation in the diagnosis of gallbladder tumors was noted.


Subclinical infection and transmission of Tyzzer's disease in rats. Two isolates of Bacillus piliformis originally obtained from rats from Japan and Indiana were compared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting. Protein and antigen profiles revealed heterogeneity between the two isolates, demonstrating that more than one isolate of B. piliformis is capable of infecting rats. Results of parallel infection and transmission studies with the two isolates were almost identical. Orally inoculated rats remained asymptomatic; however, enzyme-linked immunosorbent assay results revealed a significant increase in serum antibodies to B. piliformis. Formalin-killed B. piliformis elicited no serum antibody response among rats inoculated orally, indicating that viable organisms, capable of replicating within the host, are needed to induce a systemic humoral response. Naive rats and weanling gerbils were housed on soiled bedding from the experimentally infected, asymptomatic, seropositive rats. Although gerbils showed no clinical signs or histopathologic evidence of Tyzzer's disease, rats housed on bedding collected 1 or 2 weeks postinoculation seroconverted and remained seropositive but asymptomatic throughout the study. These results demonstrate that subclinically infected rats are capable of transmitting B. piliformis to naive rats and suggest that the histopathologic evaluation of sentinel gerbils may not be an effective method for detecting all strains of B. piliformis.


Rederivation of rat colonies seropositive for Bacillus piliformis and the subsequent screening for antibodies. Latent infection of rats in a breeding colony with Bacillus piliformis detectable by antibodies to the agent in an immunofluorescence assay was eliminated by a combination of traditional rederivation techniques, using animal units not previously used for rat breeding, and the use of specific disinfection procedures. The success rate was apparently correlated with the use of peracetic acid instead of aldehyde products to decontaminate the animal unit.


Correlation between megaloileitis and antibodies to Bacillus piliformis in laboratory rat colonies. Rat colonies in which antibodies to Bacillus piliformis were detected in animals examined at the age of 8 to 15 weeks were compared with rat colonies where no such antibodies were present. The seropositive colonies had a low incidence of megaloileitis in 5-week-old rats of Sprague-Dawley stock and some few inbred strains. In seronegative colonies, no megaloileitis was detected. In rats with megaloileitis, significantly high titers to B. piliformis were noted and the agents could be identified in the ileal mucosa by immunofluorescence technique.


Pulmonary clearance of Mycoplasma pulmonis in rats with respiratory viral infections or of susceptible genotype. We sought to determine whether or not increased severity of bronchopulmonary disease due to Mycoplasma pulmonis infection in rats with respiratory viral infections and in rats of susceptible genotype could result from altered pulmonary clearance. Pathogen-free rats were exposed to aerosols of radiolabeled M. pulmonis and the numbers of M. pulmonis colony-forming units, and amounts of radiolabel in the lungs were determined immediately after exposure or 4 hours later. Intrapulmonary killing of M. pulmonis during the 4-hour interval was determined from decreases in ratios of colony-forming units to radiolabel, and physical clearance was determined from decreases in radiolabel. Neither intrapulmonary killing nor physical clearance differed between control F344 rats and F344 rats inoculated with Sendai virus or sialodacryoadenitis virus, or between F344 and LEW rats. Rates of intrapulmonary killing and physical clearance were 64 +/- 3% and 44 +/- 2%, respectively (overall means +/- standard error).


Naturally occurring aortic aneurysms in owl monkeys (Aotus spp.). Spontaneous aortic aneurysms were diagnosed in 22 owl monkeys (Aotus spp.) at necropsy. There were 6 males and 16 females. Clinical findings varied including weight loss, weakness, and lethargy and were not present in all animals. Aortic lesions ranged in size from 2 mm to 3 cm in diameter. Nineteen of the aneurysms were classified histologically as dissecting and three as saccular. Lesions occurred less often in karyotype I monkeys than in karyotype II or III monkeys. The etiopathogenesis of aortic aneurysm in owl monkeys is unknown.


Transplantation of half kidneys in swine: I. Long-term survivors of hemirenal autotransplants. We describe a novel model of hemirenal transplantation in swine wherein one-half of one kidney is autotransplanted by modifications of standard vascular anastomoses and ureteropyelostomy. Two pigs with hemirenal transplants performed in this manner have not only survived but have grown normally and had decreased but stable renal function for more than 1 year. The model confirms that one-fourth of the total renal mass is sufficient to sustain life and growth in pigs. It is anticipated that this model could be used to study the effects of renal ablation on remnant nephrons in pigs.


Regulation of phosphoenolpyruvate carboxykinase mRNA in mouse liver, kidney, and fat tissues by fasting, diabetes, and insulin. Previous investigations of the phosphoenolpyruvate carboxykinase (PEPCK) gene have been conducted using rats. In a recent comparative study, we investigated, for the first time, the effects of fasting, refeeding, alloxan-induced diabetes, and insulin treatment on the levels of PEPCK mRNA in mouse liver, kidney, and adipose tissues. As in rats, fasting and diabetes induced, while insulin repressed, hepatic PEPCK mRNA. In contrast, the response of renal PEPCK mRNA to fasting, refeeding, and diabetes in mice differed quantitatively with that in rats: fasting caused a twofold increase in mice and a fourfold increase in rats. Moreover, diabetes, which induces renal PEPCK mRNA indirectly by causing acidosis in rats, was without effect in mice. In adipose tissue, the results of previous studies in both rats and mice have shown that the amount of PEPCK protein and its rate of synthesis are increased by fasting and diabetes and decreased by refeeding and insulin treatment. Thus, it was surprising to find that fasting, refeeding, alloxan-induced diabetes, and insulin treatment had no effect on adipose tissue PEPCK mRNA in either rats or mice.


Evaluation of maternal and fetal factors in reduced postnatal survival of NC-eob mutant mice. It has been reported that mouse pups bearing a newly identified mutation, eyelids open at birth (eob), as a homozygous condition often die within 7 days after birth although they have no external malformations other than open eyelids. We sought to determine what factors influence the viability of eob pups by performing a cross-fostering experiment using NC and NC-eob mice which are co-isogenic with each other. Viability indices of NC pups during days 0 to 7 of lactation were approximately 95% or more when they were fostered by either NC or eob mothers. However, the viability indices of eob pups were reduced to 87.3% and 36.7% when they were fostered by NC and eob mothers, respectively. Body weight gains of both NC and eob pups were slightly inhibited during the entire lactation period when they were fostered by eob mothers. In a second experiment, eob mothers were examined for milk-yielding capability and the fetuses examined for the presence of congenital visceral and skeletal malformations. Neither decreased amounts of suckled milk nor malformations were observed. Based on these results, we concluded that a remarkably high mortality of eob pups would be caused only when weak lethal factors in eob pups were combined with the slightly depressed pup-rearing capability in eob mothers.


Evaluation of greyhound susceptibility to malignant hyperthermia using halothane-succinylcholine anesthesia and caffeine-halothane muscle contractures. We investigated Greyhounds because of prior reports of malignant hyperthermia (MH) episodes and because Greyhounds may express high genetic relatedness due to inbreeding for generations. Seven Greyhound and six mongrel dogs were given halothane and succinylcholine anesthesia as a challenge to trigger MH. They also underwent semitendinosus muscle biopsy for contracture study with halothane and caffeine. Measurements in vivo of mixed venous and arterial blood gases, cardiac output by thermodilution, temperature, blood pressure, and pulse rate provided sequential data regarding whole body O2 consumption (product of cardiac output and arterial-mixed venous O2 content difference), acid-base status, and arterial CO2 tension. Greyhounds and mongrels had uniformly similar in vivo and in vitro responses, without evidence for MH. Contracture thresholds were higher than those reported for normal swine and humans (8 mM vs. 4 mM). Information on MH susceptibility in this breed is important for laboratory investigation in Greyhounds as well as to veterinary medicine in general. Neither mongrels nor this group of Greyhounds were obviously susceptible to MH. If all Greyhounds are genetically homologous, then Greyhounds may not be specifically MH susceptible. These findings overall may provide a protocol and baseline normal comparative data for determining MH susceptibility in dogs and other species.