The neuromuscular effects of ORG9426 in patients receiving balanced anesthesia

In searching for a nondepolarizing muscle relaxant with intermediate duration but more rapid onset of action than the presently available compounds, the neuromuscular and circulatory effects of ORG9426 were investigated in two studies in humans receiving fentanyl, droperidol, thiopental, and nitrous oxide-oxygen anesthesia. Eighty patients, randomly assigned to one of four groups of 20 each, received 0.12, 0.16, 0.20, or 0.24 mg/kg ORG9426. In the first study, the doses (in milligrams per kilogram) of ORG9426 that caused 50% (ED50), 90% (ED90), or 95% (ED95) neuromuscular block were determined by the individual dose-response method; they were 0.170, 0.268, and 0.305 mg/kg, respectively. In the second study, after induction of anesthesia, patients received 0.6 mg/kg (about 2 x ED95) of ORG9426, either in a single bolus (group 1) or in two unequal (0.1 and 0.5 mg/kg) increments 4 min apart (group 2). After the administration of 0.6 mg/kg ORG9426, maximal neuromuscular block developed in 1.5 +/- 0.12 min in group 1 and in 1.2 +/- 0.14 min in group 2. Patients tracheas were intubated after development of the maximal neuromuscular effect of the intubating dose and after the recording of heart rate and systolic and diastolic blood pressure. There was no difference in the clinical duration of the intubating doses, which were 40.0 +/- 3.2 (15-73) min in group 1 and 39.3 +/- 2.4 (19-57) min in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Giant aneurysms of the horizontal segment of the anterior cerebral artery: report of two cases

Two cases of giant aneurysm of the horizontal segment of the anterior cerebral artery (A1) are presented. The rare occurrence of a giant aneurysm in this location necessitates evaluation of the cross-flow through the anterior communicating artery when planning surgical strategy. On the basis of angiographic findings, trapping of the A1 on both sides of the aneurysm neck was performed in Case 1, and aneurysmorrhaphy utilizing an angioplastic multiple-clipping method of A1 endarterectomy was accomplished in Case 2. The postoperative courses of both patients were satisfactory.

Thalamic atrophy following cerebral infarction in the territory of the middle cerebral artery

We investigated shrinkage of the ipsilateral thalamus following infarction in the territory of the middle cerebral artery in 33 patients who were admitted less than or equal to 2 days after the stroke and who were followed by computed tomography for greater than 1 year with no recurrences. The thalamic area was measured on the computed tomograms, and the ratio of the ipsilateral area to the contralateral area was calculated. All values were compared with values from the initial computed tomogram taken less than or equal to 2 days after the stroke. The values of the ratio on follow-up computed tomograms decreased gradually in 15 patients. In these cases, the area of the ipsilateral thalamus was significantly reduced after 1 year (p less than 0.01) and marked atrophy was observed. These results demonstrate the significance of remote changes over a long period of time after focal cerebral infarction.

Unusual spontaneous entrapment of a dissecting aneurysm of the vertebral artery--case report

The authors report a case of subarachnoid hemorrhage due to spontaneous dissection of the intracranial segment of the left vertebral artery. Serial angiography demonstrated spontaneous entrapment of the lesion 4 months after ictus.

Presynaptic interaction between vagal and sympathetic innervation in the heart: modulation of acetylcholine and noradrenaline release

It is generally accepted that there is a functional antagonism between the sympathetic and parasympathetic (vagal) effects on the heart. In this study guinea-pig right atria loaded either with [3H]noradrenaline or [3H]choline were used and the release of [3H]noradrenaline or [3H]acetylcholine in response to field stimulation was measured under conditions when the negative feedback modulation was excluded. Strong evidence was obtained for a one-sided interaction between the sympathetic and vagal nerves at the level of the prejunctional axon terminals that send the final chemical message to the heart muscle affecting heart rate and force. Acetylcholine released from the vagal nerve inhibited its own release and also decreased the release of noradrenaline from the sympathetic axon terminals through muscarinic receptor stimulation. But muscarinic receptors located on cholinergic axon terminals are different from those present on the noradrenergic axon terminals. There is a significant difference in the dissociation constants (Kd) of different antimuscarinic drugs: The Kd values of pancuronium on vagal and sympathetic axon terminals were 5.68 +/- 0.41 and 7.20 +/- 0.25, respectively. By contrast, noradrenaline released from the sympathetic nerves or exogenous noradrenaline were not able to modulate the release of acetylcholine from the cholinergic axon terminals even under condition when the negative feedback modulation of acetylcholine release was excluded. These findings indicate that vagal axon terminals are not equipped with alpha 2- or alpha 1-adrenoceptors. However, noradrenaline released from the sympathetic axon terminals was able to inhibit its own release via alpha 2-adrenoceptor stimulation.

The pre- and postjunctional components of the neuromuscular effect of antibiotics

The relative contributions of the pre- and postsynaptic components of the myoneural blocking effect of different antibiotics were studied using: (a) a radio-active method that measures selectively the Ca(2+)-dependent, stimulation evoked, quantally released, (3)H-acetylcholine ((3)H-ACh) from the mouse in vitro phrenic nerve-hemidiaphragm preparation without cholinesterase inhibition; (b) measurement of the force of contraction of the indirectly or directly stimulated muscle. The antibiotics studied (neomycin, polymyxin B and lincomycin), reduced the release of (3)H-ACh evoked by stimulation (18 trains of 40 shocks at 50 Hz) in a concentration dependent manner. While the inhibitory effect of neomycin was inversely related to [Ca(2+)](o), that of lincomycin was moderately and that of polymyxin B was not affected by increasing [Ca(2+)](o) from 0.75 to 5.0 mM. Similarly, the d-tubocurarine (d-Tc)-induced inhibition of the release of (3)H-ACh was independent of [Ca(2+)](o). The K-channel blocking agent, 4-aminopyridine (4-AP), enhanced the release of ACh in a concentration dependent manner and prevented the neuromuscular effect of neomycin. However, the neuromuscular effect of polymyxin B and of lincomycin was not affected by 4-AP. Atropine, enhanced the release of (3)H-ACh. Antibiotics, however, were still able to reduce the release of ACh when the negative muscarinic feedback mechanism of ACh release was eliminated by atropine. Our findings indicate that the antibiotics studied possess both pre- and postsynaptic effects. Presynaptically they reduce the evoked release of ACh; postsynaptically they inhibit muscle contractility. The rank order of presynaptic action is neomycin >polymyxin B >lincomycin.

[Effect of extracorporeal shock wave lithotripsy on renal function-an experience with the new type piezoelectric lithotripter, Therasonic]

Seventeen patients with renal stones and 17 patients with ureteral stones were treated using the newly developed piezoelectric shock wave lithotripter, THERASONIC. To determine the effect of shock wave on renal function, urinary N-acetyl-beta-D-glucosaminidase (NAG) activity, urinary beta 2 microglobulin (BMG) concentration, serum BMG concentration and creatinine clearance (Ccr) were measured. Urinary NAG activity and urinary BMG concentration in renal stone patients were significantly elevated immediately after the treatment and returned to the pretreatment value within 24 hours. Neither serum BMG nor Ccr showed significant change in any of the patients. Therefore, we conclude that the renal tubular damage, which is transient and subtle, is the effect of shock wave lithotripsy using THERASONIC machine.

Temperature dependence of rat diaphragm muscle contractility and fatigue

The diaphragm is a skeletal muscle of mixed fiber type that is unique in its requirement to maintain contractile function and fatigue resistance across a wide range of temperatures to sustain alveolar ventilation under conditions of hypo- or hyperthermia. The direct effect of temperature (15-41 degrees C) on rat diaphragm isometric contractility and fatigue was determined in vitro. As temperature decreased from 37 to 15 degrees C, contraction and relaxation times increased, and there was a left shift of the diaphragm's force-frequency curve, with decreased contractility at 41 and 15 degrees C. Fatigue was induced by 10 min of stimulation with 30 trains/min of 5 Hz at a train duration of 900 ms. Compared with 37 degrees C, fatigue resistance was enhanced at 25 degrees C, but no difference in fatigue indexes was evident at extreme hypothermia (15 degrees C) or hyperthermia (41 degrees C). Only when the fatigue program was adjusted to account for hypothermia-induced increases in tension-time indexes was fatigue resistance evident at 15 degrees C. These findings indicate that despite the diaphragm's unique location as a core structure, necessitating exposure to in vivo temperatures higher than found in limb muscle, the temperature dependence of rat diaphragm muscle contractility and fatigue is similar to that reported for limb muscle of mixed fiber type.

Cloning of hepatitis C virus genomes and their properties

A random primed lambda gt11-cDNA library was constructed from donors plasma presumably infected by blood-borne non-A, non-B hepatitis (hepatitis C:HC) agent and immunoscreened with serum pooled from patients with acute or chronic HC. Twelve lambda gt11-cDNA clones were isolated that was shown to encode antigens associated specifically with HC infection in Japan as well as in USA. Of these two, as well as another clone which is specific only to Japanese HC infection, have unique nucleotide sequences and were extensively studied. They are not derived from host DNA and have no homology to the sequences of known human viruses including hepatitis A, B and D viruses, Ebstein-Barr virus, coxsackievirus, immunodeficiency virus type 1 or Japanese encephalitis virus. These results suggest that they are derived from the genome of HC agent(s). In addition, of these, one clone seems to encode epitopes derived from both the core and the surface polypeptides of the agent.

[Treatment of urinary stones with Therasonic, the third generation piezoelectric shock wave lithotripter]

The THERASONIC lithotripsy treatment system, a newly developed piezoelectric lithotripter, uses both an X-ray and ultrasound system and enables stone localization effective. Treatment of urinary stones with THERASONIC was begun in June, 1989 and 57 treatments have already been performed on 38 patients. Successful treatment, defined as either stone free or with a residual stone less than 4 mm in diameter on flat X-ray film, was accomplished in 95% of the renal stones and over 50% of the ureteral stones. The overall success rate was 74%. Blood pressure and laboratory values did not show any significant change during or after the treatment. No major complication has been observed except for one perirenal hematoma which was resolved with conservative therapy.

Neuromuscular and cardiovascular effects of pipecuronium

Pipecuronium bromide (Arduan) is a bisquaternary, steroid-type neuromuscular blocking agent in clinical use in Eastern Europe. Before its introduction into clinical practice in the USA, in the first phase of this study the neuromuscular potency of pipecuronium was determined under "balanced" and enflurance anaesthesia by the cumulative log dose-response method in 30 patients each. In the second phase the intubation and onset times, clinical duration of the first and repeated doses, spontaneous recovery index, reversibility of its residual neuromuscular effect by an anticholinesterase and its effect on heart rate and blood pressure was compared with the same variables observed in patients, anaesthetized with identical techniques but who had received vecuronium or pancuronium. The neuromuscular potency of pipecuronium was greater under enflurane (ED95 = 23.6 +/- 1.1 micrograms.kg-1 (mean +/- SEM)] than under balanced (ED95 = 35.1 +/- 17 micrograms.kg-1) anaesthesia. Pipecuronium was more potent than vecuronium under both balanced (ED95 = 45.8 micrograms.kg-1) and enflurane anaesthesia (ED95 = 27.4 micrograms.kg-1). Following the administration of 2 x ED95 doses there were no clinically significant differences in the intubation or onset times of pipecuronium, vecuronium and pancuronium. Under balanced anaesthesia the clinical duration of 2 x ED95 dose of pipecuronium (110.5 +/- 0.3 min) or pancuronium (115.8 +/- 8.1 min) were similar and about three times longer than that of vecuronium (36.3 +/- 2.1 min). The recovery indices of pipecuronium (44.5 +/- 8.2 min) and pancuronium (41.3 +/- 4.2 min) were also similar and about three times longer than that of vecuronium (14.3 +/- 1.4 min).(ABSTRACT TRUNCATED AT 250 WORDS)

[Embryo collection from miniature pigs and production of the piglets after transfer to common pig recipients]

Embryo collection from Göttingen miniature pigs and transfer to common pig recipients were performed. Embryos were collected 2 to 6 days after the onset of estrus. Two to 7 eggs including unfertilized ova were collected from a naturally ovulated donor and more eggs (7 to 15) were obtained from a superovulated donor. A total of 21 piglets were born after transfer of 33 miniature pig embryos to two common pig recipients. Among them 12 were stillbirths which seemed to have resulted from suffocation during the parturition. Such an embryo transfer technique will be utilized as an inventive method for the purposes such as international exchange of the particular strains of miniature pigs, establishment of a SPF miniature pig herd and so on.

The survival of whole and bisected rabbit morulae after cryopreservation by the vitrification method

The survival of whole and bisected rabbit morulae cryopreserved by the vitrification method was investigated. The embryos were loaded in a column of vitrification solution (VS, a mixture of 25% glycerol and 25% 1, 2-propanediol in PBS+16% calf serum), which was located between two columns of 1 M sucrose solution in a plastic straw. The embryos were frozen by being plunged into liquid nitrogen and thawed in a water bath at 20 degrees C. Two methods of loading embryos into straws were used: the single and double column vitrification solution methods. The embryonic survival rates between these two methods were compared. Seventy-one (86.6%) out of 82 morulae vitrified in double column straws developed into the blastocyst stage in vitro. Eleven (18.3%) live fetuses were obtained after the transfer of 60 frozen-thawed morulae to four recipients. By contrast, the survival rate (36.5%, 27 74 ) of embryos vitrified in the single column straws was significantly lower (P<0.05). The vitrification solution of the single column straws became opaque, indicating ice-crystal formation, upon thawing in 5 of 11 straws, which was assumed to have damaged the embryos. More than 80% (29 36 ) of the bisected morulae frozen and thawed in the double column straws developed to the blastocyst stage in vitro when cryoprotectant was diluted stepwise with 1 M and 0.25 M sucrose solution. When the cryoprotectant was removed by one-step dilution with 1 M sucrose solution, swelling in blastomeres was observed and the development rate of the recovered embryos decreased (45.8%, 11 24 ). These results indicate that the vitrification method employed in our experiment is not only efficient for the cryopreservation of rabbit morulae, but it can also be used for the preservation of bisected rabbit morulae, which had not been successful using previous methods.