[Cervical spine movement during orotracheal intubation using the McCoy laryngoscope compared with the Macintosh and the Miller laryngoscopes]

The movement of cervical spine during orotracheal intubation was compared using the McCoy, Macintosh or Miller laryngoscope blade. Twenty ASA 1-2 patients requiring tracheal intubation were studied. Following induction of anesthesia and obtaining muscle relaxation, the cross-table lateral X-ray was taken before and during laryngoscopy using three types of laryngoscopes. Degree of cervical spine movement was evaluated by measuring the distance between the spinous processes of C1 and the occiput, and the amount of displacement of C1 and C5 against C3 by tracing on each films. The results indicated that delta C1-occiput was larger and delta C1 + C5 smaller with the McCoy laryngoscope compared with the others. The use of the McCoy laryngoscope results in less cervical spine movement during laryngoscopy and therefore should be of particular benefit in the presence of cervical spine instability as well as in the normal patients.

Primary adenocarcinoma in the urethrorectal fistula

A 60-year-old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996.

[Rapid induction of anesthesia with propofol--comparison with thiopental]

We investigated hemodynamic changes, induction time and the incidence of pain after rapid induction of anesthesia with propofol (Group P) in comparison with those after induction with thiopental (Group B). Anesthesia was induced with propofol 2.5 mg.kg-1 in Group P and thiopental 5 mg.kg-1 in Group B taking 20 seconds. When verbal response disappeared, tracheal intubation was performed with suxamethonium 1.2 mg.kg-1. The incidence of pain on injection, time from the start of injection of the drug to the disappearance of verbal response (induction time), blood pressure, heart rate, and rate pressure product (RPP) were monitored. The pain on injection was seen in 6 of 30 patients in Group P. This was significantly larger compared with 3 patients in Group B. The induction time was not different between the two groups. One minute after intubation, blood pressure, heart rate and RPP were significantly higher compared with those before induction in Group B. These were also significantly higher than those in Group P. Therefore, rapid induction with propofol is more useful compared with that with thiopental.

Optimal dose of thiamylal in combination with midazolam for induction of anaesthesia

PURPOSE

The optimal dose range of thiamylal, combined with midazolam, in the induction of anaesthesia was evaluated using haemodynamic variables.

METHODS

The 200 patients, aged 30 to 70 yr, were randomly divided into five groups by midazolam dosage. Anaesthesia was induced with midazolam 0.05, 0.075, 0.10, 0.15, or 0.20 mg.kg-1. Two minutes later, 50 mg thiamylal was administered followed by 25 mg increments until verbal response and eyelash reflex disappeared and blood pressure decreased to a level less than that of preinduction. Tracheal intubation was performed with 0.15 mg.kg-1 vecuronium. Blood pressure and heart rate were monitored during induction. Optimal induction was defined as a systolic blood pressure one minute after intubation within +/- 20% of that before induction.

RESULTS

There were 164 patients whose systolic blood pressure were within these criteria. Blood pressure decreased two minutes after induction and 3 to 15 min after intubation in all groups. Heart rate increased one minute after intubation in 0.05 mg.kg-1, 0.075 mg.kg-1 and 0.10 mg.kg-1 midazolam groups. The optimal range of thiamylal was 4.0 +/- 1.1 (mean + SD), 3.1 +/- 1.2, 2.8 +/- 1.1, 2.3 +/- 1.2, and 1.7 +/- 1.0 mg.kg-1 in combination with midazolam 0.05, 0.075, 0.10, 0.15, and 0.20 mg.kg-1, respectively.

CONCLUSION

The optimal dose range, to maintain haemodynamic stability, for thiamylal induction of anaesthesia in combination with midazolam, 0.05-0.2 mg.kg-1 was found to range from 4.0 to 1.7 mg.kg-1.

IL-10 production in mouse hepatocytes augmented by TGF-beta

The supernatant from normal liver cell (Clone 1469) culture enhanced polyclonal antibody production in mouse spleen cells but not in human peripheral blood lymphocytes. The supernatants from transforming growth factor beta (TGF-beta)-treated C3H/HeN spleen cells augmented greatly polyclonal antibody responses compared with the untreated supernatants. IL-10 production and expression of mRNA for IL-10 in Clone 1469 cells was detected by using enzyme-linked immunosorbent assay, ELISPOT assay and PCR amplification. TGF-beta led to augmentation of IL-10 secretion from Clone 1469 cells.

[Kinetics of peripheral blood CD34-positive cells and optimal timing of blood stem cell harvest after urological anticancer chemotherapy]

PURPOSE

We evaluated the changes in stem cells in peripheral blood and the optimal timing for harvesting peripheral blood stem cells (PBSCs) following the administration of conventional cancer chemotherapy in patients with urological malignancies.

PATIENTS AND METHODS

We evaluated the changes in PBSCs after the administration of cancer chemotherapy in 12 patients with urological malignancies (6 testis cancer, 3 bladder cancer, 3 prostate cancer) using flowcytometry analysis of CD34, a marker of blood stem cell. We evaluated the optimal timing for PBSCs harvesting following the administration of conventional cancer chemotherapy in 6 patients with urological malignancies (2 patients with testis cancer, 3 patients with prostate cancer, 1 patient with bladder cancer) using flowcytometry analysis of CD34 and granulocyte-macrophage colony-forming units (CFU-GM) counts. PBSC samples from 2 patients with prostate cancer were analyzed by the reverse transcriptase-polymerase chain reaction (RT-PCR) method to detect prostate cancer cells.

RESULTS

The percentages of CD34-positive cells tended to increase in the peripheral blood during the period of convalescence that followed the induction of marked myelosuppression produced by the cancer chemotherapy. The peak in CD34-positive cells occurred between days 15 and 31 after beginning of cancer chemotherapy. The percentage of CD34-positive cells was increased in the mononuclear cells in harvested PBSCs. The percentages of CD34-positive cells in peripheral blood and in mononuclear cells harvested from PBSCs was correlated with the CFU-GM counts in harvested PBSCs. The CFU-GM counts peaked between days 16 to 31 following cancer chemotherapy. RT-PCR detected prostate-specific antigen (PSA) mRNA expression in PBSCs obtained from 1 of the 2 patients with prostate cancer. An amount of contamination with PSA mRNA reduced as chemotherapy was repeated.

CONCLUSION

A sufficient number of PBSCs can be harvested after conventional cancer chemotherapy without the need for special cytotoxic mobilization that may be delayed the patient's treatment. RT-PCR results suggested that the harvested PBSCs should be examined for tumor cell contamination in patients with metastasis in bone marrow. If a sufficient amount of PBSCs will be harvested, the PBSC samples from the patient with bone marrow metastasis after repeated chemotherapy should be used by priority for PBSC transplantation as of today.

Enzyme-linked immunosorbent assay using cysteine proteinase antigens for immunodiagnosis of human paragonimiasis

An enzyme-linked immunsorbent assay (ELISA) using worm extract antigens from lung flukes of Paragonimus westermani provided good sensitivity to sera from patients with paragonimiasis westermani but high cross-reactivity with sera from most fascioliasis patients and some patients with onchocerciasis or clonorchiasis. To improve the specificity, we tested an ELISA using fluke cysteine proteinases as antigens. Cysteine proteinases were partially purified from the excretory/secretory products of P. westermani by 40-75% ammonium sulfate fractionation, hydrophobic chromatography, and arginine affinity chromatography. An ELISA using the enzyme preparation not only had increased sensitivity to paragonimiasis westermani sera but also reduced cross-reactivity with the fascioliasis, onchocerciasis, and clonorchiasis sera to negligible levels. The reactivity of the ELISA to paragonimiasis miyazakii sera was similar to that of paragonimiasis westermani sera. A proteinase preparation from P. ohirai, which can be obtained easily from infected rats, provided similar results. Therefore, the ELISA using cysteine proteinases of Paragonimus could not distinguish the parasite species with which patients were infected, but it is a valuable assay with which to immunodiagnose paragonimiasis even when the proteinases are prepared from nonhuman species.

[A new medium sized probe of the non-tactile type for tympanic membrane temperature monitoring]

The probe TTS-400 for the tympanic membrane temperature monitoring of non-tactile type Bi-Temp TM-200D for adult patients is big enough to cause bleeding sometimes in the external acoustic canal because it is easy to bend its tip against the wall of the canal, inducing a wrong measurement. Therefore, we developed a new medium sized probe and compared the efficacy of the probe to the ordinary adult type probe. In six patients under general anesthesia, 54 measurements of tympanic membrane temperature were performed using both probes and simultaneous monitoring of rectal temperature was performed. The bending of the tip of the probe was seen in 20/54 measurements of the adult type probe, which was with more than 9/54 measurements of the medium sized probe. The bleeding was seen in two patients of the adult type probe and only one patient of the medium sized probe. There were good correlations in the measured temperatures between the adult type probe and the medium sized probe. These two measured temperatures correlated well with the rectal temperature. In conclusion, a new medium sized probe is useful in clinical settings.

Inorganic fluoride kinetics and renal tubular function after sevoflurane anesthesia in chronic renal failure patients receiving hemodialysis

Although sevoflurane is used in clinical anesthesia, its effects on renal function and inorganic fluoride (F-) kinetics in patients with chronic renal failure (CRF) have not been determined. We investigated F- kinetics and renal tubular function in sevoflurane anesthesia in CRF patients having hemodialysis. Five patients dialyzed and five with normal renal function undergoing parathyroidectomy or thyroidectomy were anesthetized with sevoflurane (1.0%-2.5%) and nitrous oxide in oxygen. Serum and urine levels of F-, blood urea nitrogen (BUN), serum creatinine (Cr), serum and urine beta 2-microglobulin (BMG) levels, and urine N-acetyl-beta-D-glucosaminidase (NAG) level were measured. BUN, Cr, and serum and urine BMG levels were significantly higher in the CRF patients than in the controls. There were no differences in serum F- level, rate of elimination, and area under the curve of serum F- levels between the two groups. However, the CRF patients had a significantly lower level of urine F- than control subjects. These data suggest that the F- kinetics in the CRF patients is different from that in normal renal function subjects. This clinical study with a limited number of patients may facilitate further studies to define the mechanisms of differences in the F- kinetics between normal subjects and CRF patients having hemodialysis after sevoflurane anesthesia.

[Perioperative management of a patient with bilateral renal cell cancer and large vena caval tumor thrombosis]

Von Hippel-Lindau disease is a kind of rare autosomal dominant hereditary disease characterized with many kinds of tumor or cystic lesion. In this 30 year old woman, vena caval tumor thrombi from retroperitoneal malignancies caused by renal cell cancer extended into the right atrium. She was scheduled to undergo bilateral radical nephrectomy and removal of vena caval thrombi under continuous hemodiafiltration (CHDF) and extracorporeal circulation. CHDF and Biomedics Pump were on stand-by during the operation. Radical left nephrectomy was performed. In the right kidney, however only the tumor could be removed and other part of the right kidney remained untouched. Therefore, CHDF was not used because urine volume and electrolyte balance were maintained with furosemide administration. The change of blood pressure caused by inferior vena caval clamping at just below the renal vein was not so great that the operation was performed without extracorporeal circulation. Total blood loss was 12,000 ml and careful management of water balance was necessary. She did not need any hemodialysis after the surgery.

[A comparative study of three types of tympanic membrane temperature monitoring]

We compared three types of tympanic membrane thermometer, Bi-Temp TM-200D (RSP), Mona-Therm (MT), and Quick Thermo (QT). RSP uses a thermister method, MT a thermo-couple method, and QT detects an infrared energy. The tympanic membrane temperature measured with RSP correlated significantly with those measured with MT or QT. RSP showed temperatures 0.5 to 0.6 degree C lower than MT and 0.3 degree C lower than QT. At the initial phase of monitoring the temperature, RSP showed a gradual increase to a stable temperature. However, MT indicated a transient increase followed by a decrease to a stable temperature. Both reached to stable temperatures in 100 to 120 seconds. These characteristics of thermometers should be considered when we compare the tympanic membrane temperature measured with various thermometers.

High-dose chemotherapy with peripheral blood stem-cell transplantation for hormone-refractory advanced carcinoma of the prostate: experience of two cases

Two patients with hormone-refractory advanced prostate cancer were treated with high-dose chemotherapy and peripheral blood stem-cell transplantation. A satisfactory number of stem cells were collected by appropriately timed leukapheresis in these patients. The stem-cell samples collected from the first patient were positive for prostate-specific antigen messenger ribonucleic acid expression; such expression was not detected in the samples from the second patient. The first patient has remained in complete remission as of December 1995. The second patient died of the disease.

[Comparison of a new double-lumen endobronchial tube by Portex with Broncho-Cath]

We compared the clinical usefulness of two double-lumen endobronchial tubes, one furnished by Concord Portex and the other Broncho-Cath by Mallinckrodt. Only left-sided 37 french size tubes were used. The difficulty of intubation, the opening state of the bilateral lumen in a bronchus, the displacement of the tube in changing a position, and easiness of passing the fiberbronchoscope or suction tube were compared in using the two double lumen endobronchial tubes. All parameters were slightly better in the Portex tube than in the Broncho-Cath, but the differences were not significant. It is concluded that the Portex tube is as useful as the Broncho-Cath or it may be superior to the Broncho-Cath.

Laparoscopic retroperitoneal nephrectomy for atrophic kidney associated with ectopic ureter in a 2-year-old girl

A 2-year-old Japanese girl underwent laparoscopic retroperitoneal surgery for removal of an atrophic left kidney located in the left retroperitoneal space that was associated with an ectopic ureter. No serious complications developed during the operation or postoperatively.

Opitz syndrome in a Japanese male

There have been only a few reports on Opitz syndrome in Japan. We report here a case of a Japanese male with canthal hypertelorism, bilateral cleft lip and palate, scrotal hypospadias with scrotal transposition, and cryptorchidism, findings that met the criteria for this syndrome. After repair of the cleft lip and palate, urethroplasty was performed at age 2, and bilateral orchiopexy was performed at age 3. At age 5, the child is of normal weight for his age, voids urine smoothly on standing, and has slight mental retardation.

[A new colorimetric CO2 indicator Colibri]

A new colorimetric carbon dioxide (CO2) indicator Colibri is a disposable, compact and light weighted device. Colibri does not need to be calibrated and is easily usable in an emergency. It indicates blue with CO2 below 4 mmHg and becomes yellow with CO2 above 40 mmHg. In comparison with EASY CAP, Colibri functions for a longer period and it has a humidifier and a bacterial filter. Colibri is useful for emergency situations and anesthetic care.

[A case of amoebiasis as a latent infection]

A 69-year-old male was admitted because of constipation and abdominal distension. A colon fiberscopic examination revealed the formation of ulceration. The trophozite of Entamoeba histolytica was detected from from the specimens of colon mucosal biopsy of the ulcer. The stool was positive for the cysts of E. histolytica too. He had been in China and Southeast Asia during World War II. He returned home and experienced amoebic dysentry, and was treated with Emethin hydrochlolide. He suffered from amoebic disentry in 1970 and was treated with Emethine hydrochrolide again. After the War he had not gone abroad, and was not a homosexual. So this case was considered a latent infection of E. histolytica from the War. This time he was treated with metronidazol and minocycline. After the therapy, cysts were negative in the stool and the ulcer was cured on the colon fiberscopic examination.

Human amnion contains a novel laminin variant, laminin 7, which like laminin 6, covalently associates with laminin 5 to promote stable epithelial-stromal attachment

Stable attachment of external epithelia to the basement membrane and underlying stroma is mediated by transmembrane proteins such as the integrin alpha6beta4 and bullous pemphigoid antigen 2 within the hemidesmosomes along the basolateral surface of the epithelial cell and their ligands that include a specialized subfamily of laminins. The laminin 5 molecule (previously termed kalinin/nicein/epiligrin) is a member of this epithelial-specific subfamily. Laminin 5 chains are not only considerably truncated within domains III-VI, but are also extensively proteolytically processed in vitro and in vivo. As a result, the domains expected to be required for the association of laminins with other basement membrane components are lacking in the mature laminin 5 molecule. Therefore, the tight binding of laminin 5 to the basement membrane may occur by a unique mechanism. To examine laminin 5 in tissue, we chose human amnion as the source, because of its availability and the similarity of the amniotic epithelial basement membrane with that of skin. We isolated the laminin 5 contained within the basement membrane of human amnion. In addition to monomeric laminin 5, we find that much of the laminin 5 isolated is covalently adducted with laminin 6 (alpha3beta1gamma1) and a novel laminin isotype we have termed laminin 7 (alpha3beta2gamma1). We propose that the association between laminin 5 and laminins 6 and 7 is a mechanism used in amnion to allow stable association of laminin 5 with the basement membrane. The beta2 chain is seen at the human amniotic epithelial-stromal interface and at the dermal-epidermal junction of fetal and adult bovine skin by immunofluorescence, but is not present, or only weakly present, in neonatal human skin.

Long-lasting immune response induced by recombinant bacillus Calmette-Guérin (BCG) secretion system

The recombinant bacillus Calmette-Guérin (rBCG) secretion system utilizing an extracellular alpha antigen of Mycobacterium kansasii (alpha-K) was characterized biochemically and immunologically. The human immunodeficiency virus type 1 (HIV-1) p17gag B cell epitope fused to alpha-K was secreted in extremely large amounts. At least three mice out of seven inoculated with rBCG generated high titres of antibody to the epitope. The long-lasting antibody production persisted more than 14 months.

The effect of ulinastatin, a human protease inhibitor, on the transfusion-induced increase of plasma polymorphonuclear granulocyte elastase

Ulinastatin (UTI), a human protease inhibitor, inhibits polymorphonuclear granulocyte elastase (PMNE) release from granulocytes stimulated by several pathologic inflammatory processes. Blood transfusions increase plasma PMNE concentrations. We evaluated the effects of UTI on the transfusion-induced increase in PMNE. Thirty-nine patients undergoing gastrectomy were divided into four groups: Group A (n = 8), blood transfusion (-), UTI (-); Group B (n = 9), blood transfusion (+), UTI(-); Group C (n = 12), blood transfusion (-), UTI(+); and Group D (n = 10), blood transfusion (+), UTI(+). UTI of 300,000 U was infused in Groups C and D. White blood cell count (WBC), segmented cell count, plasma PMNE concentration, and PMNE release (PMNE concentration/segmented cell) were measured before, at the end of, and at 1 and 3 days after the operation. Although no significant differences were seen in WBC and segmented cell count among the groups, plasma PMNE concentration and PMNE release in Group B (transfusion without UTI) were significantly more than in Group A (no treatment) and Group D (transfusion with UTI) at the end of the operation, but the concentrations of the variables were not significantly different between Groups A and C (only UTI treatment). These results indicate that a single injection of 300,000 U of UTI inhibited transfusion-induced PMNE increase at the end of the operation. Thus, the present results may facilitate future studies testing the effects of UTI given at larger doses, or by a continuous administration, on the prevention of organ derangement after blood transfusion.

[Usefulness and radiopacity of the two radiopaque epidural catheters]

We evaluated the radiopacity and usefulness of the two radiopaque epidural catheters, one by Portex CO. Ltd., and the other Flex Tip Plus with a stainless coil by Arrow Japan Co. Ltd. The Portex catheter (Group A) or the Arrow catheter (Group B) was inserted through a single epidural space from Th7 to Th12 in 20 patients each. The two plain chest X-rays, one for the lung and the other for the catheter, were taken in all patients after surgery. We compared the two groups and examined whether the identification of the catheter was possible or not in the two kinds of X-rays, whether the catheter had gone straight or not, and whether the insertion of the catheter had been easy or difficult. The course of the catheter was identified easily in 1 case of Group A and 4 cases of Group B but was not identified at all in 10 cases of Group A and 8 cases of Group B. There were no differences between the two groups in the number of patients in whom the catheter was easily inserted, identified, or placed straight. Therefore, the usefulness of the two catheters in terms of insertion and identification of its course was not different.