Alternative treatment may lower the need for use of extracorporeal membrane oxygenation

Access to artificial surfactant and high frequency oscillatory ventilation (HFO) in Japan seems to affect the actual indications for extracorporeal membrane oxygenation (ECMO). The relation between the methods of treatment and survival and/or neurological sequelae of 27 neonates with severe respiratory failure who would have met the US ECMO entry criteria in the Neonatal Intensive Care Unit of National Children's Hospital, Tokyo between January 1988 and May 1992 were retrospectively analyzed. Out of 27 neonates, conventional treatment including artificial surfactant was successful in 6 cases (22%). High frequency oscillatory ventilation was used for the 21 cases who did not respond to conventional treatment and it was effective in 5 cases (19% of total). Extracorporeal membrane oxygenation was used on 11 (40% of total) of 16 cases who did not respond to HFO. Eight (29% of total or 73% of ECMO cases) of these cases survived and 3 cases (11% of total) died. The remaining 5 cases (19% of total) who met the exclusion criteria of ECMO died. No patient with respiratory distress syndrome (RDS) became ill enough to meet the US ECMO entry criteria. Six out of 8 congenital diaphragmatic hernia cases were saved on a delayed surgery protocol with HFO. Only about 1% of the neonates who were admitted to our NICU during the last 4 years needed ECMO treatment. Forty-one per cent of the patients who would have met the US ECMO entry criteria were treated successfully without ECMO. The necessity for ECMO is less in Japan than in the US because other methods can often be used successfully to treat severe respiratory disorders.

Inflammatory chemical mediators during conventional ventilation and during high frequency oscillatory ventilation

Inflammatory chemical mediators, platelet-activating factor (PAF), thromboxane (TX) B2, and 6-keto-prostaglandin (PG)F1 alpha, were extracted from lung lavage fluid after conventional mechanical ventilation (CMV) and high frequency oscillatory ventilation (HFOV) to clarify the relation between mode of ventilation and lung injury in surfactant-depleted rabbit lungs. Anesthetized adult rabbits were tracheostomized, and surfactant depletion was induced by repeated saline lavage. Lung lavage for measurement of mediators was performed after 4 h of CMV at an FIO2 of 1.0 and a mean airway pressure of 15 cm H2O or HFOV (15 Hz) at an FIO2 of 1.0 or 0.21 and a mean airway pressure of 15 cm H2O. The number of total cells and polymorphonuclear leukocytes (PMN) and the levels of PAF, TXB2, and 6-keto-PGF1 alpha were measured by radioimmunoassay. Total respiratory compliance (Crs) was measured by the passive flow-volume curve method. The numbers of PMN, and the levels of PAF and TXB2 in lung lavage fluid were significantly greater during CMV than during HFOV. HFOV resulted in decreased production of PAF and TXB2 in a surfactant-depleted rabbit lung. Crs was significantly less during CMV than during HFOV. These results suggest that HFOV could prevent the release of such inflammatory chemical mediators and result in less lung injury than CMV.

Lack of satiety effect of cholecystokinin (CCK) in a new rat model not expressing the CCK-A receptor gene

This work expands recent observations that Otsuka Long-Evans Tokushima Fatty (OLETF) rats show little or no pancreatic expression of the cholecystokinin (CCK)-A receptor gene. We examined whether the CCK-A and -B receptor genes were expressed in the brain (hypothalamus) of OLETF rats in comparison with control (Long-Evans Tokushima Otsuka = LETO) rats. CCK-A receptor mRNA was detected in the hypothalamus of LETO rats but not OLETF rats. The CCK-B receptor gene was expressed in the hypothalamus in both strains. Cerebroventricular administration of CCK-8 sulfate inhibited daily food intake in LETO rats, but not in OLETF rats. These results show that in OLETF rats the absence of CCK-A receptor gene expression in the hypothalamus results in hyperphagia because of lack of satiety.

Mechanisms of stimulatory effect of neuromedin C on pancreatic exocrine secretion in conscious rats

The mechanisms of the stimulatory effect of the bombesin-like peptide neuromedin C on pancreatic exocrine secretion were examined in conscious rats. Rats were prepared with cannulae draining bile and pancreatic juice separately. Intravenous infusion of 0.35 nmol/kg/h of neuromedin C significantly increased the secretions of pancreatic bicarbonate and protein, and transiently increased the plasma cholecystokinin (CCK) concentration. The increase in pancreatic secretion persisted for 90 min, whereas the increase in plasma CCK was observed only after 15 and 30 min from the beginning of neuromedin C infusion. Intravenous infusion of CR-1409, a specific CCK-receptor antagonist, inhibited, but did not abolish, the protein secretion stimulated by neuromedin C. Intraduodenal infusion of a potent proton pump inhibitor, omeprazole, suppressed, but did not abolish, protein secretion induced by neuromedin C. Omeprazole abolished the increase in bicarbonate secretion produced by neuromedin C. These results indicate that neuromedin C induces release of CCK and that its induction of pancreatic hypersecretion is due to both its direct effect and CCK. The results also suggest that gastric hypersecretion may have a role in the bicarbonate hypersecretion induced by neuromedin C.

Lack of effect of cholecystokinin receptor antagonist (CR1505) on recovery of experimental pancreatitis after pancreatic duct occlusion in rats

The effect of long term administration of a synthetic cholecystokinin (CCK) receptor antagonist CR1505 (loxiglumide) on pancreatitis was examined in rats after pancreatic duct ligation (PL) with an internal bile fistula. All rats were given both 6 mg/day of CR1505 continuously infused intraduodenally with an osmotic pump and 32 mg/day introduced into the stomach with an orogastric tube. Rats were killed 7, 14, and 28 days after PL, and changes of body weight, pancreatic wet weight, daily food intake, pancreatic protein content, and histology, plasma amylase concentration, and both plasma and duodenal CCK concentrations were examined. Administration of CR1505 for 7 days from immediately after PL, resulted in decrease of body weight, increase of daily food intake, and significant increases of intestinal CCK concentration and the level of CCK mRNA. However, its administration from day 7 to day 14 or 28 did not improve any of the parameters examined except inflammatory infiltration of the pancreas on the 14th postoperative day. These results suggest that CR1505 may have a beneficial effect on recovery from pancreatitis when administered during the early stage, but not when administered during a later stage.

Antiandrogenic activity and endocrinological profile of a novel antiandrogen, TZP-4238, in the rat

TZP-4238 is a new potent, orally active steroidal antiandrogen. Antiandrogenic activity and endocrinological profile of TZP-4238 were investigated in rats, except that progestational activity was determined in rabbits. TZP-4238 suppressed the testosterone propionate-induced increases in the weights of the ventral prostate, seminal vesicle and levator ani in castrated immature male rats. TZP-4238 also decreased the weights of the ventral prostate, seminal vesicle and levator ani in intact adult male rats, but did not affect the weight of the testis or the serum concentrations of luteinizing hormone and testosterone. TZP-4238 did not have such an inhibitory effect on the weight of the adrenal gland as seen in other steroidal antiandrogens. It exhibited potent progestational activity. Although TZP-4238 did not exert androgenic or estrogenic activity, it had weak antiestrogenic activity. These results suggest that TZP-4238 exerts an antiandrogenic effect on the prostate without any compensatory change in the serum concentration of luteinizing hormone or testosterone in rats, and it is a useful drug for the treatment of androgen-dependent diseases such as prostatic hypertrophy and prostatic cancer.

Influence of in vivo copper on MR images of the liver in rats

To investigate the effects of in vivo copper on magnetic resonance (MR) images, the authors studied Long-Evans cinnamon rats, which develop hepatitis and hepatocellular carcinoma as a result of abnormal copper metabolism. The livers of the rats were imaged before hepatitis developed; the absence of hepatic disease was confirmed histopathologically. The copper that accumulated in the liver of the rats was thought to exist in the form of divalent ions, which were suspected of reducing the T1 and T2 of neighboring protons. However, the signal intensities of the liver on T1- and T2*-weighted images did not change, suggesting that in vivo copper, even when accumulated abnormally, does not influence the signal intensity of MR images.

Voluntary control of saccadic eye movement in patients with frontal cortical lesions and parkinsonian patients in comparison with that in schizophrenics

To investigate whether the abnormalities of antisaccades in schizophrenics could be explained by a dysfunction of the frontal cortex, we examined 10 patients with frontal cortical lesions and 22 patients with idiopathic Parkinson's disease with mild symptoms (Yahr I-II) using the same tasks, and compared the results with those obtained in schizophrenics. The frontal patients with lesions covering the frontal eye field and prefrontal cortex showed more errors, longer latencies, and lower peak velocities in the antisaccade task, despite giving normal results in the visually guided saccade task. This was similar to the results observed in schizophrenics. Parkinsonian patients did not consistently show a significant difference in the antisaccade task. These results indicate specific abnormalities of antisaccades in schizophrenics and patients with frontal cortical lesions but not consistently in Parkinsonian patients. This suggests that the abnormalities of antisaccades in schizophrenics might be explained by a frontal cortical dysfunction.

Direct, concentration-dependent inhibition by taurocholate of pancreatic exocrine secretion and CCK release in conscious rats

In conscious rats, bile inhibits pancreatic secretion. The role of luminal taurocholate (TC), a major component of rat bile, in the regulation of pancreatic secretion was studied in conscious rats with external bile and pancreatic fistulae. On the fourth postoperative day, after the basal collection of bile and pancreatic juice (PJ) returned to the duodenum, graded doses of TC (0, 0.4, 4, 40 mM) containing 10 mM CaCl2 were infused into the duodenum instead of bile and PJ for 2 hr (1 ml/hr), with or without 1 mg/ml of porcine trypsin. Luminal trypsin activities were not affected by any dose of TC. The increases in pancreatic secretion in response to diversion of bile and PJ were progressively inhibited with increasing doses of infused TC from 0 mM to 4 mM both with and without trypsin infusion. The effects with 4 and 40 mM TC were not significantly different. Changes in plasma cholecystokinin concentrations roughly correlated with changes in protein output in rats without trypsin infusion. We concluded that TC directly inhibited pancreatic secretion independent of the luminal trypsin activity and that its inhibitory action was concentration dependent.

Effect of a new cholecystokinin antagonist (FK 480) on gene expression of cholecystokinin and secretin in rat intestine

The effects of a new cholecystokinin (CCK) antagonist (FK 480; 0.1 mg/kg per day given by intragastric administration to rats for 3 days) on the expression of the CCK and secretin genes, plasma CCK immunoreactivity, and CCK content in the intestinal mucosa were examined. FK 480 increased the level of CCK mRNA in the intestine to 1.7 times the level in control rats, but did not affect the level of secretin mRNA. It did not increase plasma CCK immunoreactivity or CCK content in the intestinal mucosa. These results suggest that the ingested FK 480 directly increased CCK mRNA level in the intestine and produced a dissociation between the synthesis and release of CCK.

Toward better home respiratory monitoring: a comparison of impedance and inductance pneumography

Various respiratory monitoring methods have been used as a part of home respiratory care, but none has been accepted as a universal method. Impedance pneumography is the most popular method at present and is used in the form of cardiorespiratory monitoring, but it has limitations for diagnosing obstructive airway problems and a high incidence of false alarms. We evaluated a new investigational method, inductance pneumography, in terms of the incidence of false alarms (waveform out of range), using infants recovering from general anesthesia. They were used for this study because they go through all the stages of sleep in a short period and their relatively long period of light sleep was advantageous in evaluating motion artifact interference. Waveforms went out of range 24.6 +/- 2.9% of the time with impedance pneumography and 15.9 +/- 4.5% with pulse oximeter, but 11.0 +/- 3.4% with inductance pneumography. These differences are statistically significant (P < 0.01). Electrocardiography electrodes for impedance pneumography dislodged briefly in one case but the Respiband dislodged in four cases and the Flex II probe dislodged in three cases, indicating the need for better fixation of sensors. It was found that inductance pneumography, in addition to being able to detect obstructive apnea, has a significantly lower incidence of false alarms. Further elaboration of this method is warranted for better home respiratory monitoring.

Pressure-volume relationships of the respiratory system in normal cats

We studied the pressure-volume (PV) relationships of the total respiratory system, lung and chest wall in 8 anesthetized and paralyzed normal adult cats. The PV relationships of the total respiratory system had a sigmoid shape with a relatively linear portion with an alveolar pressure between 0 to +15 cmH2O. The relative impact of the lung and chest wall to the total elastic recoil forces of the respiratory system was approximately equal within a physiological pressure range. The results suggest that measurements of PV relationships of the respiratory system may offer a physiologic basis for accurate interpretation of pulmonary functions, leading to a better therapeutic strategy in animals with lung diseases.

Two cases of proton MR spectroscopy of the brain after irradiation

Proton magnetic resonance spectroscopy (1H-MRS) is thought to be more sensitive to radiation damage of the brain than magnetic resonance imaging (MRI). We presented performed 1H-MRS using the stimulated echo acquisition method (STEAM) for non-tumor sites in 2 patients who received radiation therapy for their brain tumors. In the first case up to 45 days after radiation, we could observe a normal spectra presented three major peaks of N-acetyl aspartate (NAA), creatine and phosphocreatine (Cr), and choline (Cho). In the second case who had radiation necrosis 1 year after radiation, the spectra showed a decrease in the all peaks beneath the noise level.

Cardiac effects of the novel pyridazinone derivative 6-[4-[2-[3-(5-chloro-2-cyanophenoxy)-2-hydroxypropylamino]- 2- methylpropylamino]phenyl]-4,5-dihydro-5-methyl-3(2H) pyridazinone monoethyl maleate and its metabolite in isolated heart preparations of guinea pigs and dogs

The cardiovascular effects of 6-[4-[2-[3-(5-chloro-2-cyanophenoxy)-2- hydroxypropylamino]-2-methylpropylamino]phenyl]-4,5-dihydro- 5-methyl-3(2H) pyridazinone monoethyl maleate (salt) (TZC-5665, CAS 114856-47-2) and its main metabolite in human, M-2, were investigated in isolated atrial and ventricular muscles of guinea pigs and dogs, in guinea pig atrial and right ventricular papillary muscles. TZC-5665 showed negative chronotropic and inotropic effects, whereas M-2 showed a potent positive inotropic effect with a slight positive chronotropic effect. The positive inotropic effect of M-2 was not modified by phentolamine, propranolol and cimetidine, but completely depressed by carbachol. In blood-perfused dog heart preparations, M-2 increased the contractile force and coronary blood flow of paced papillary muscles and sinus rate. Although TZC-5665 scarcely affected the contractile force and sinus rate, it increased coronary blood flow. TZC-5665 scarcely affected atrio-ventricular (AV) conduction time, whereas M-2 slightly shortened AV conduction time. The rate of ventricular automaticity was slightly increased by M-2, but suppressed by TZC-5665 at higher doses. TZC-5665 showed a non-selective beta-adrenoceptor blocking activity comparable to that of propranolol in guinea-pig atrial and tracheal preparations. In enzyme preparations, TZC-5665 and M-2 were more potent and selective inhibitors of phosphodiesterase (PDE) III than milrinone. Combination of beta-adrenoceptor blocking effect of TZC-5665 and positive inotropic effect of M-2 could be useful in the treatment of congestive heart failure by mutual prevention of undesirable effects.

Clinical experience of Hokkaido University-PACS and FCR-angiography

Three years' experience with Hokkaido University-PACS (HU-PACS) is reported. In particular, this paper describes the suitability of FCR-angiography for HU-PACS, which has been in clinical use since March 1991. Image quality of FCR-arteriograms was evaluated in the head-and-face region and the abdominal region independently. The image quality in both regions was excellent. Quality of transferred images to image workstation for HU-PACS with 10:1 data compression was also evaluated, and no appreciable image degradation or loss of information was found in the transferred images. There was no significant difference in the examination time required for one patient in abdominal angiography between conventional angiography and FCR-angiography. In summary, FCR-angiography is suitable for HU-PACS as its image acquisition modality.

The effect of a long term (6 months) treatment with (-)deprenyl on antioxidant enzyme activities in selective brain regions in old female Fischer 344 rats

The effect of long term treatment with (-)deprenyl (s.c. injection three times a week for 6 months) on superoxide dismutase (SOD) and catalase (CAT) in selective brain regions was examined in old (22 months) female Fischer 344 rats. The three doses of deprenyl used (0.1, 0.25 and 0.5 mg/kg/day) increased the activities of both enzymes in substantia nigra, striatum and cerebral cortices essentially in a dose dependent manner. However, for CAT activities in cerebral cortices, the smallest dose of 0.1 mg/kg/day was most effective, while the highest dose (0.5 mg/kg/day) had no effect. In contrast to these brain regions, there were no significant differences in enzyme activities between control and deprenyl-treated groups in the hippocampus and cerebellum. If the effect of deprenyl on the life span of female F-344 rats is causally related to its effect on antioxidant enzyme activities in selective brain regions as shown in this study, then a dose of 0.25 or 0.5 mg/kg/day appears to be most appropriate. Since this dose is much lower than the dose suggested by our previous short term (3 week) experiments, an even longer term experiment is necessary to determine the optimal dose of deprenyl to increase free radical scavenging and thus possibly extend lifespan.

[The present state of ECMO for newborn infants and children]

Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is considered to provide not only lung support but also cardiac assist to acute cardiac or pulmonary failure of the newborn infants and children. However, an excessive "LUNG REST" strategy may lead to myocardial hypoxic damage in patients without PDA or any left-to-right cardiac shunt. The estimation of pulmonary vascular resistance and cardiac contractility, which is independent of preload, afterload and heart rate, is very important for the selection of ECMO, vascular access and weaning strategy from ECMO. Introduction of new ECMO techniques including heparin-coated or FUT-175 infused circuit, ECMO into double-lumen venous cannulas, the other therapies, such as artificial surfactant therapy, high frequency oscillation or inhaled nitric oxide can affect our approaches toward patients with severe cardiorespiratory failure.

Expression of the cholecystokinin precursor gene in rat tissues

Cholecystokinin, a brain gut peptide that stimulates gall bladder contraction and pancreatic exocrine secretion, also acts as a neurotransmitter. In this study, we demonstrated that small amounts of cholecystokinin precursor mRNA were expressed in the heart, lung, and kidney, as well as in the brain and the small intestine. The nucleotide sequences of the coding regions of the cholecystokinin precursor mRNA in these tissues were identical to those of the small intestine, indicating that cholecystokinin precursor proteins produced in these tissues are identical to those in small intestine. This is the first report demonstrating that the cholecystokinin precursor gene is expressed in the heart, lung, and kidney, as well as in the gastrointestinal tract and brain.

Little or no expression of the cholecystokinin-A receptor gene in the pancreas of diabetic rats (Otsuka Long-Evans Tokushima Fatty = OLETF rats)

Expression of the CCK-A receptor gene in the pancreas and pancreatic exocrine function was examined in diabetic model rats (OLETF) at 5 wks of age. Little or no CCK-A receptor was detected in the pancreas of OLETF rats. Pancreatic exocrine function in response to exogenous CCK and to bile-pancreatic juice diversion (endogenous CCK) was impaired in conscious OLETF rats. The pancreatic insulin and protein contents of OLETF (Otsuka Long-Evans Tokushima Fatty) and control LETO (Long-Evans Tokushima Otsuka) rats were not significantly different. No histological abnormalities or expression of pancreatitis associated protein (PAP) mRNA was detected in the pancreas in either group. These results suggest that OLETF rats are a new experimental model for congenital deficiency of CCK-A receptor in the pancreas.

[Effect of bilateral truncal vagotomy on cholecystokinin release and pancreatic exocrine secretion in conscious rats]

The effects of bilateral truncal vagotomy on cholecystokinin (CCK) release and pancreatic hypersecretion produced by bile and pancreatic juice (BPJ) diversion were examined in conscious rats. In addition, the effect of exogenous administration of CCK-8 (100 pmol/kg/h) on pancreatic secretion were compared in rats with and without vagotomy. Rats were prepared with external bile and pancreatic juice fistulae and the experiment was conducted on the 4th postoperative day. Basal pancreatic secretion was not affected by vagotomy. CCK release produced by bile and pancreatic juice diversion was enhanced, whereas protein secretion in response to high plasma CCK was inhibited by vagotomy. Pancreatic secretion stimulated by intravenous infusion of 100 pmol/kg/h of CCK-8 was also inhibited by vagotomy. These results proposed that vagal nerve is mandatory for the full response of pancreatic exocrine secretion to circulating CCK.

Increased pulsatile movement of the hindbrain in syringomyelia associated with the Chiari malformation: cine-MRI with presaturation bolus tracking

Cine-MRI with presaturation bolus tracking was used in patients with syringomyelia associated with a Chiari malformation to study pulsatile movement of the hindbrain, cervical spinal cord, cerebrospinal fluid and the fluid within the syrinx. Nine patients had 13 examinations, 6 preoperative, 3 after syringosubarachnoid shunting and 4 after posterior fossa decompression. Five controls were also examined. Dynamic display of the acquired images demonstrated downward displacement of the presaturation bolus on the cerebellar tonsils and medulla oblongata (or upper cervical cord) at the C1 level in all preoperative examinations and in two patients after syringosubarachnoid shunting but with residual foramen magnum obstruction. Downward displacement of the bolus on the cervical spinal cord was also demonstrated in 7 examinations, but not observed in the controls. Thus, the hind-brain-spinal cord axis showed larger pulsatile movements in patients with foramen magnum obstruction. Based on these observations and a review of the literature, a new theory on the mode of extension of syringomyelia, emphasising the role of increased pulsatile movement of the hind-brain-spinal cord axis is proposed: that the pulsatile movements, together with a one-way valve mechanism in the syrinx cavity act as a "vacuum-pump" to enlarge the syrinx.

Role of high-frequency ventilation in surfactant-depleted lung injury as measured by granulocytes

Granulocytes were collected from the lung lavage fluid of surfactant-depleted rabbits to assess the relationship between granulocyte-related lung injury and ventilatory mode. The number of lavaged granulocytes was determined after 2 and 4 h of conventional mechanical ventilation (2CMV and 4CMV, respectively) or high-frequency oscillatory ventilation (2HFO and 4HFO, respectively). Stimulated respiratory bursts were assayed by luminol-dependent chemiluminescence (LDCL) with N-formyl-methionyl-leucyl-phenylalanine (FMLP) stimulation in four groups of rabbits. The number of lavaged granulocytes significantly increased with ventilatory duration in the CMV mode but not in the HFO mode. Meanwhile, peak LDCL response value with FMLP stimulation in 4CMV was substantially lower than values in the other three groups. The decrease in the granulocyte LDCL response in 4CMV suggests oxygen metabolite exhaustion in the cells. CMV increasingly induced the accumulation of granulocytes with activated respiratory bursts in the alveolar spaces with ventilatory duration. HFO did not cause granulocyte accumulation, nor did it impair granulocyte function. The results suggest that HFO is useful for the prevention of lung injury related to activated granulocytes.

Analysis of longitudinal distribution of pulmonary vascular resistance by use of a five element lumped model

To analyze longitudinal distribution of pulmonary vascular resistance, we proposed a five element lumped model which partitioned pulmonary circulation into pulmonary arterial, middle and pulmonary venous segment. The validity and anatomical correlation of the model were tested in an isolated, perfused, canine lung lobe preparation with inflow/outflow occlusion techniques. With arterial occlusion, pulmonary arterial pressure fell rapidly and then exponentially. With venous occlusion, pulmonary venous pressure rose suddenly and then exponentially. Theoretical pressure profiles produced by computer simulation of the model well approximated the general characteristics of the experimental traces. Serotonin increased the pressure gradient across the pulmonary arterial segment (delta Pa), whereas histamine increased the gradient across the pulmonary venous segment (delta Pv). Neither drug altered the gradient across the middle segment (delta Pm). The results suggest that the lumped model is a useful concept to understand the longitudinal distribution of pulmonary vascular resistance, and that delta Pa, delta Pm and delta Pv reflect the resistance distribution of anatomical pulmonary arteries, alveolar vessels and pulmonary veins, respectively.

Effect of long-term exercise under restricted-feeding on intestinal content of cholecystokinin and on the pancreas in aging rats

The effects of exercise (5000 m/day running from 100 to 600 days of age) on the cholecystokinin (CCK) content in the proximal intestine, and the enzyme and insulin contents of the pancreas were examined in food-restricted rats. Food restriction decreased the body weight and the wet weights of the pancreas and proximal intestine but not the wet weight of the stomach. Food restriction also decreased the chymotrypsin content of the pancreas but not its amylase content. The contents of enzymes in the pancreas were not affected by exercise. The insulin content of the pancreas was lower in lean rats produced by food restriction and/or exercise than in controls. Exercise increased the wet weight of the proximal intestine and the CCK content of the intestine. The increase in the CCK content may be due to compensational change in the efficiency of digestion of luminal nutrients induced by exercise.