[Mild hypothermia in patients with senile dementia]

From the viewpoint of the high frequency of mild hypothermia in patients with senile dementia, we investigated causative factors in comparison with accidental hypothermia. We also investigated the relationship between hypothermia and the type or grade of dementia. A total of 127 demented cases including 30 males and 97 females, whose mean age was 80.6 +/- 8.9 years, were classified into 3 groups according to the axillary temperature measured in August 1989. Group A consisted of 33 cases whose body temperature was below 36 degrees C on more than 25 days. Group C consisted of 24 cases whose body temperature was above 36 degrees C on more than 25 days, and the remaining 70 cases were classified as group B. The frequency of group A classification in demented patients was higher than age-matched non-demented controls (26% vs 13%, p less than 0.05). In demented males, serum total cholesterol, serum albumin, and hemoglobin were significantly higher in group A than in group B or C. Body weight and serum triglyceride were also higher in group A, but not significantly. In demented females, serum albumin and hemoglobin were higher in groups A and B than group C. In addition, cases with diabetes mellitus or cases receiving with major tranquilizers were more frequent in group A, and the index of activities of daily living was higher in group A, in both sexes. Factors such as age, CRP or thyroid hormone (free T3, free T4) showed no significant difference among the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Regional immunochemotherapy for liver metastasis of esophageal cancer in a patient with variant hepatic artery]

A patient with metastatic liver tumor from esophageal cancer having an anomaly of the hepatic artery was treated by regional immunochemotherapy using two infuserports, which were implanted transfemoral to the right and the left hepatic artery, respectively. The schedule of this therapy was as follows: CDDP (30 mg/m2) on day 1 and 8, 5-FU (1,000 mg/m2) on day 1, 2, 8, 9, 15 and 22, and OK-432 (1 KE/body) on day 3-6, 10-13 and 16-20 were administered via the hepatic artery; and OK-432 (5 KE/body) was also injected intramuscularly three times a week. After the first course of this therapy was performed via the left hepatic artery, metastatic foci in the left lobe regressed, while those in the right lobe progressed markedly. Thereafter, the second course was performed via the right hepatic artery, and then the third course was via both right and left hepatic artery. Following these trials, metastatic foci of the right and the left lobes showed remarkable regression. These results suggest that the effect of immunochemotherapy is closely related with the local concentration of anti-cancer agents.

[A case of recurrent pelvic tumor of sigmoid colon cancer showing partial response to lipiodolization]

We performed lipiodolization and immunochemotherapy for recurrent pelvic tumor of sigmoid colon cancer using an infuserport which was implanted and connected to the catheter placed in the right internal iliac artery. Following lipiodolization, the level of CEA (980 ng/ml) decreased to within the normal range. MRI showed necrotic change and regression (more than 50%) of tumor. DSA revealed disappearance of tumor neovascularity. No serious side effect but skin erosion in the gluteal region was encountered after lipiodolization. This result suggests that lipiodolization is worth performing in further clinical trials for pelvic tumor.

Infective endocarditis of the tricuspid valve in a non-drug user

A case of infective endocarditis of the tricuspid valve is described in a young female patient with no history of intravenous drug abuse. The patient suffered from symptoms of septic emboli of the lung and right heart failure. She was ultimately treated by tricuspid valve replacement. There was no recurrence of symptoms following surgery.

[Effect of intrapleural and/or intraperitoneal lentinan therapy in carcinomatous pleuritis and peritonitis]

Seventeen lesions in fourteen patients with malignant pleural and/or peritoneal effusion were treated with the intrapleural and/or intraperitoneal Lentinan therapy (4 mg/week x 4). The following results were obtained. Malignant effusion disappeared in four lesions and diminished in two. In ten lesions, the cytological grade decreased. Totally, thirteen lesions (76.5%) revealed clinical effect. Toxicity, caused a high fever in only one case. Subpopulations (CD4, CD8, Leu7, CD8+ CD11+) of pleural or peritoneal effusion mononuclear cells (PEM) and peripheral blood mononuclear cells (PBM) showed no change during the course of Lentinan therapy. NK and anti-Daudi activities of PEM tended to be augmented and high LAK activities of PEM were maintained by Lentinan therapy. However, NK activities of PBM after this therapy were significantly lower than before therapy (p less than 0.05). Augmentation of cytotoxicity in PEM induced by Lentinan may lead to clinical effect. Thus, this therapy may be useful for even patients with end-stage carcinoma.

[Intraarterial combination immunotherapy in hepatocellular carcinoma]

Unresectable hepatocellular carcinoma (HCC) has a poor prognosis and little sensitivity to anticancer agents. We planned a combination immunotherapy, associating with rIL-2 continuous injection. Combination immunotherapy consists of 5 different biological response modifiers (BRM), i.e., rIL-2, OK-432, adriamycin (ADR), cyclophosphamide (Cy), and famotidine (Fa). rIL-2, OK-432 and ADR were administered from implantable infuser port connecting to a catheter which was injected into the hepatic artery via the gastroduodenal artery under laparotomy. OK-432, Cy, and Fa were also administered systemically. From 1988 to 1990, seven patients with unresectable HCC and two patients who underwent curative resection were treated by this therapy. The objective responses were evaluated by CT and angiography. This combination immunotherapy produced 3 cases of complete response and 2 of minor response. Immunological monitoring of lymphocyte subsets and NK activity of peripheral blood mononuclear cells was also performed. NK activity was significantly augmented and the percentage of Leu 7(-) NCD 16(+) cells increased during this therapy. Serious toxicity, but transient high fever and hypotension, was not observed during this therapy. All of these patients left the hospital within two weeks and returned to their previous job or similar life activity. These results suggest that this combination immunotherapy is worth performing in further clinical trials for hepatocellular carcinoma.

[Usefulness of measurement of hepatic arterial blood flow during surgery to insert an arterial reservoir in unresectable hepatocellular carcinoma]

In a case of hepatocellular carcinoma, complicated with celiac arterial constriction, for which resection was impossible, we measured the blood flow in the hepatic artery using an ultrasonic, transit-time rheometer during surgery, and consequently inserted a reservoir safely. The measurement of the blood flow in this case demonstrated that the proper hepatic artery was provided with blood from superior mesenteric artery by the gastroduodenal artery and that the blood flow of the common hepatic artery was directed to the root part of the celiac artery. Moreover, because blood flow through the proper hepatic artery was greater while clamping the common hepatic artery than the gastroduodenal artery, cannulation was carried out from the common hepatic artery. Postoperatively, when recombinant interleukin-2(rIL-2) was infused from the reservoir, the tumor disappeared on imaging pictures, and the level of AFP (which was high preoperatively) was reduced, which was thus judged as a complete response. These results indicated the usefulness of measurement of blood flow in surgery of inserting a reservoir in cases with abnormal blood circulatory dynamics.

[Effect of intrapleural and/or intraperitoneal lentinan therapy on carcinomatous pleuritis and peritonitis with special reference to immunological evaluation]

Eleven patients, seven with carcinomatous pleuritis and four with carcinomatous peritonitis, were treated with the intrapleural and/or intraperitoneal administration of Lentinan (4 mg/week X 4). And the following results were obtained. (1) Eight patients revealed a clinical effect; malignant effusion disappeared in two and diminished in two. In six, the cytological grade decreased. (2) Subpopulations of peripheral blood lymphocytes (PBL) and pleural or peritoneal effusion mononuclear cells (PEMNC) were examined using monoclonal antibodies (OKT4, OKT8, Leu7, CD8 X CD11). These showed no change during the course of treatment. (3) NK activities of PBL didn't improved but those of PEMNC significantly improved (P less than 0.01) during this therapy. Anti-Daudi activities of PEMNC tended to be augmented during this therapy. Especially in effective cases, anti-Daudi activities were highly augmented. (4) As a side effect, only one showed an elevation of body temperature. These results indicate that intrapleural and/or intraperitoneal Lentinan administration is a useful treatment for carcinomatous pleuritis and peritonitis.

Inotropic effects of Ca2+ channel agonist and antagonists in neuraminidase-treated left atria of rats

The effects of removal of sialic acid from cardiac sarcolemma on contractile functions and on inotropic responses to Ca2+ channel agonist and antagonists were investigated in rat left atria. About 64% of the total sialic acid content of the left atria was removed during a 90 min exposure to neuraminidase (2 u ml-1). The removal of sialic acid neither affected the development of twitch tension induced by stimulation at a frequency of 0.5 Hz, nor altered the interval-dependent changes in contractility such as the force-frequency relationship and post rest contractions. The positive inotropic effects produced by isoprenaline, and by an increase in extracellular Ca2+ concentration were the same in the neuraminidase-treated preparations as those in the untreated preparations. Bay K 8644, a Ca2+ channel agonist, induced an increase in contractility in the neuraminidase-treated preparations comparable to that in the untreated ones. Neuraminidase treatment significantly attenuated the negative inotropic effects of verapamil and diltiazem, whereas it had no effect on that of nifedipine. The results indicate that sialic acid removal modifies neither the basal contractile functions nor the positive inotropism which is associated with an enhancement of the slow inward Ca2+ current. However, sialic acid, which constitutes the glycocalyx of the cardiac sarcolemma, may be involved in the mechanism of the Ca2+ channel antagonistic actions of verapamil and diltiazem, but not that of nifedipine. Thus, our results provide pharmacological evidence that verapamil and diltiazem behave differently from the dihydropyridine compounds.

Specific production of eosinophil colony stimulating factor from sensitized T cells from a patient with allergic eosinophilia

To explore the possibility that an eosinophil colony stimulating factor (EO-CSF) is elaborated independently of neutrophil CSF (N-CSF), we compared the effect on the production of EO-CSF and N-CSF of adding a specific antigen, an aspergillus extract, to peripheral blood leucocytes of an eosinophilic patient with allergic bronchopulmonary aspergillosis. Conditioned media prepared from the patient's mononuclear (MN) and T cells were assayed for EO-CSF and N-CSF activities by agar culture technique, using normal human nonphagocytic MN bone marrow cells as target cells. The addition of the specific antigen to the cultures of the patient's MN or T cells significantly stimulated the production of EO-CSF, but not that of N-CSF, while the patient's non-T cells and normal MN or T cells were not stimulated by the antigen challenge to produce either CSF. These results suggest that EO-CSF is a factor distinct from N-CSF, that its production is dependent on the presence of sensitized T cells with antigen-specific stimulation, and that it might be one of the causes of blood eosinophilia in this patient.

Delayed afterdepolarisations and triggered activity in canine Purkinje fibres treated with neuraminidase

We investigated the electrophysiological alterations induced by the removal of sialic acid from the sarcolemma in canine Purkinje fibres. About 70% of total sialic acid content of Purkinje fibres was removed by 120 min of exposure to neuraminidase (1 U X ml-1). The treatment with neuraminidase did not change any of the action potential characteristics at normal Ca2+ concentration (2.7 mmol X litre-1). However, action potential duration and maximum upstroke velocity of phase zero of the action potential were reduced to a greater degree in neuraminidase-treated Purkinje fibres than in non-treated controls at high Ca2+ concentration (8.1 mmol X litre-1). At high Ca2+ concentration, delayed afterdepolarisations were induced in five out of nine neuraminidase-treated Purkinje fibres and triggered activity was observed in two, when driven in trains of 20 stimuli of different cycle length (1000 to 180 ms). No discernible delayed afterdepolarisations were observed in nine non-treated control Purkinje fibres. In addition, the amplitude of delayed afterdepolarisations induced by ouabain (0.2 mumol X litre-1) in neuraminidase-treated Purkinje fibres was larger than non-treated controls. These findings suggest that sialic acid residues of glycocalyx function as a kind of barrier to Ca2+ influx.

[Effects of sulfhydryl reagents on sodium-calcium exchange system in canine cardiac sarcolemmal vesicles]

Using a sarcolemmal vesicle-enriched preparation prepared from canine ventricles, the effects of several sulfhydryl reagents on the Na+-Ca2+ exchange were examined. N-Ethylmaleimide (NEM) significantly inhibited the intravesicular Na+ (Na+i)-dependent Ca2+ uptake but did not remarkably affect the extravesicular Na+ (Na+o)-dependent Ca2+ efflux. Iodoacetamide (IAM) had no significant effect on the Na+i-dependent Ca2+ uptake and somewhat promoted the Na+o-dependent Ca2+ efflux. Dithiothreitol (DTT) did not significantly influence the Ca2+ uptake, was inclined to increase passive Ca2+ efflux and apparently decreased the Ca2+ efflux. DTT added with IAM exhibited a significant depressant effect on the Ca2+ uptake and simultaneously had a remarkable increasing effect on passive Ca2+ efflux. NEM and (DTT + IAM), however, did not significantly alter the Km value for Ca2+. p-Chloromercuribenzoate (PCMB) remarkably inhibited the Na+i-dependent Ca2+ uptake but simultaneously showed a remarkable promoting effect on passive Ca2+ efflux, whereby the Na+o-dependent Ca2+ efflux was factually counteracted. These results suggest the possibility that the direction of the Na+-Ca2+ exchange might be controlled by a modification with NEM and IAM of the thiol group(s) in the protein involved in the Na+-Ca2+ counter-transport and that the reductive cleavage of disulfide bond(s) and a modification with PCMB of thiol group(s) present in the sarcolemmal vesicle-associated protein(s) result in an increased Ca2+ permeability in the vesicular membrane.