A simple method for monitoring muscular relaxation during continuous infusion of vecuronium

There is considerable individual variation in the dose of vecuronium required for the maintenance of surgical relaxation. Therefore to provide uninterrupted relaxation without overdosage it is advisable to regulate the IV infusion of vecuronium on the basis of appropriate monitoring. Monitoring with mechanomyography (MMG) or electromyography requires costly equipment and is too complex for routine clinical use. Visual observation of the adductor pollicis muscle contracting against zero resistance is not suitable for the reliable assessment of the degree of neuromuscular (NM) block. For clinical purposes satisfactory monitoring can be achieved with the simple device (Myoscan) described. The reliability of the Myoscan was tested in 30 patients by simultaneous monitoring of the force of contraction of the adductor pollicis on one side with the Myoscan and on the contralateral side with the MMG. Retrospective analysis of the MMG indicated that the conduct of anaesthesia would have been virtually the same if it would have been based on MMG monitoring.

Production of normal piglets from microsurgically split morulae and blastocysts

The embryo splitting technique was applied to pig embryos, and the developmental ability of the split embryos was examined by means of in vitro culture and transfer. Morulae, early blastocysts and blastocysts were collected from Landrace x Large White F(1) gilts which had been mated to Duroc boars. The embryos were bisected with a fine glass or alloy (PtIr) needle after the softening of zonae pellucidae. The halved-embryos, which had either been placed in zonae pellucidae or not, were transferred to recipient gilts immediately after the micromanipulation (Experiment 1) or after cultivation for 15 to 20 h (Experiment 2). In Experiment 1, two fetuses were obtained from one of three recipients which had received 12 half-embryos. In Experiment 2, three of five recipients became pregnant, and in one recipient, seven piglets of a litter were obtained from 12 zona-free half-embryos produced from the original seven blastocysts. The results obtained indicate that a simple method not requiring the encasing of split embryos into zonae pellucidae is satisfactory to produce viable half-embryos.

Are fluorescent bodies of Y-spermatozoa detectable in common with mammalan species?

An attempt was made to detect the fluorescent bodies (F-body), using Quinacrine mustard (Q-M) staining in the spermatozoa from eight mammalian species (human, bull, boar, dog, rabbit, rat, mouse, and mastomys) as well as in the cock (used as negative control). Sperm suspension, prepared after rinsing by repeated centrifugation with phosphate buffered saline (PBS), was either stained with Q-M for 24 h or treated with protease and then stained with Q-M for 60 min. The final concentration of Q-M in the mixed staining sperm suspension was 0.025 mg/ml. The examination using a reflecting fluorescent microscope revealed that the F-body found in human sperm was also present in the sperm of all the mammals but not in the cock after 24 h of staining. The enzyme-treated specimens showed higher incidences of F-bodies than specimens stained for 24 h without enzymatic digestion. These findings strongly suggest that the F-body is commonly present in the spermatozoa of many mammalian species.

Follow-up study of 582 liver cirrhosis patients for 26 years in Japan

A long-term follow-up study of liver cirrhosis (LC) was performed in 582 patients diagnosed by peritoneoscopy and liver biopsy in the 26 years from 1958 to 1984. The etiology of LC consisted of hepatitis B virus (HBV) in 21%, alcoholic in 39% and cryptogenic in 39%. Fifty-nine percent of patients had died. Causes of death were hepatocellular carcinoma (HCC 44%), liver failure (30%), rupture of esophageal varices (14%), gastrointestinal bleeding (4%) and non-liver-related causes (8%). HCC accounted for increasing percentages (68%) since 1980. In all groups classified by the etiology, the causes of death had the same order in incidence. The age of onset of LC increased by 10 years from 42 to 52 years old and the age of death by 15 years from 43 to 58 in the 26-year period. The cumulative survival rate improved over the period. The 50% survival year was 7.9 in total patients, and 7.0, 8.5 and 10.0 in the three periods 1958-64, 1965-74 and 1975-84, respectively. It was 9.5, 6.3 and 9.8 in HBV, alcoholic and cryptogenic, respectively. LC patients survived 40-44% of the life expectancy of the general population in Japan in all age groups. Cox's multiregression life-table method selected three important prognostic factors from 7 parameters: a poor prognosis with a history of heavy alcohol consumption and old age at onset, and a better prognosis with recent onset.

Enhancement of low-dose N-2-fluorenylacetamide-induced hyperplastic liver nodules by pre-existing cirrhosis

The potentiating effect of pre-existing cirrhosis on the formation of hyperplastic liver nodules and/or foci was investigated by feeding a low dose (0.008%) of 2-N-fluorenylacetamide (FAA) in a choline-deficient (CD) diet for 32 weeks to cirrhotic and non-cirrhotic rats. Liver cirrhosis was induced by feeding the rats a CD diet for the preceding 36 weeks. The number and area of gamma-glutamyltranspeptidase-positive hyperplastic liver nodules and/or foci were significantly larger in cirrhotic rats exposed to low-dose FAA than in non-cirrhotic rats similarly treated. Hyperplastic liver nodules and/or foci were not observed in rats continuously fed a CD diet alone for 68 weeks (control cirrhotic rats). The results suggest that cirrhotic liver might alter the metabolic response to FAA, even at low doses, and lead to enhanced induction of hyperplastic liver nodules and/or foci.

Elevation of type V collagen-degrading enzyme activity in invasive hepatocellular carcinoma

Type V collagen-degrading enzyme activity in the cancer front was extremely high in a hepatocellular carcinoma (HCC) patient with severe metastasis to the lungs. However, the similar results were not found in other two patients with only slight or no metastasis.

Subgenomic studies on hepatitis B virus DNA integrated into the genome of hepatocellular carcinoma

Integration of hepatitis B virus (HBV) DNA into the chromosomal DNA of hepatocellular carcinoma (HCC) tissue was studied by the Southern blot analysis using probes for subgenomic regions C, PreS, S and X. Eighteen Hind III-fragments prepared from DNA of the tumor regions of six patients with HCC, and hybridized with a full genomic HBV probe were analyzed. Lack of region S or PreS was concurrently accompanied by deletion of their 3'-end region of the HBV minus strand DNA. Region C was missing in 11 out of 18 fragments while regions X, S and PreS were deleted in 5/18, 3/18 and 5/18 respectively. Therefore, in some sequences integrated by subgenomic HBV DNA, the integration of replicative intermediate of the HBV minus strand DNA into the chromosomal DNA may take place and one of the viral integration sites seems to be in the region X.

Expression of ABH and Lewis blood group antigens in combined hepatocellular-cholangiocarcinoma. Possible evidence for the hepatocellular origin of combined hepatocellular-cholangiocarcinoma

Expression of ABH, Lewis, and sialyl Lea antigens was studied in five combined hepatocellular-cholangiocarcinomas. Formalin-fixed liver tissues were immunostained for those antigens using well-characterized monoclonal antibodies and an avidin-biotin-peroxidase complex (ABC) method. Results were compared with those obtained in normal liver tissues and cholangiocarcinomas, and also with the previous observations of the authors on hepatocellular carcinomas. Although not detected in normal parenchymal liver cells, A, H, Lewis, and sialyl Lea antigens were found in combined hepatocellular-cholangiocarcinoma cells. Incompatible A antigen also was detected in one blood type O patient. Distribution and intensity of the antigens were similar to those in hepatocellular carcinomas and different from those in cholangiocarcinomas. No preferential accumulation of blood-group antigens could be found in the area of cholangiocarcinoma-like differentiation of the combined hepatocellular-cholangiocarcinoma. The observations suggested that Regional morphological differentiation of the hepatocellular-cholangiocarcinoma might not be always associated with the change in the expression of the blood group antigens. Moreover, the expression was essentially the same between the hepatocellular-cholangiocarcinoma and the typical hepatocellular carcinoma. The hepatocellular-cholangiocarcinoma, therefore could be a variant of the hepatocellular carcinoma.

Pharmacokinetic studies of cimetidine in patients with liver disease

The tolerability and metabolism of cimetidine administered for over 7 days were studied in 30 patients with liver diseases and 19 control subjects who had peptic ulcers. Cimetidine was well tolerated by these patients without any side effects. The cimetidine in the serum and urine was determined by high-performance liquid chromatography. The serum cimetidine levels and pharmacokinetic parameters of the patient group did not significantly differ from those of the control group after oral administration. Following intravenous administration, the half-life of cimetidine increased and cimetidine clearance decreased in the liver disease group. These differences seem to be totally explicable by the impaired renal function associated with the liver disease. Furthermore, accumulation of cimetidine in serum did not occur following continuous treatment with cimetidine in these patients. It was concluded that a reduction of cimetidine dosage is not necessary in patients with liver disease as far as their renal function is not disturbed, since the metabolism of cimetidine was not affected by the liver dysfunction itself.

Modulation of stimulation-evoked release of newly formed acetylcholine from mouse hemidiaphragm preparation

A radioisotope method has been developed for measuring the stimulation-evoked release of acetylcholine without the use of cholinesterase inhibitors from the mouse hemidiaphragm preparation which had been loaded with 3H-choline. Evidence has been obtained that 3H-choline was taken up by and released from both innervated and non-innervated mouse hemidiaphragm preparations. However, it was released in the form of 3H-acetylcholine in response to electrical field stimulation only from the innervated preparations. Long lasting (51 min) S1 stimulation of the preparations exhausted the radioactive acetylcholine stores to the extent that S2 did not evoke any release of 3H. These data suggest that when the labelled acetylcholine stores become exhausted, the labelled choline, still present in the tissue, cannot be released by electrical stimulation. Tetrodotoxin (1 mumol/l) administration and Ca withdrawal inhibited, 20-100 mumol/l 4-aminopyridine enhanced the release of 3H-acetylcholine in response to electrical stimulation. Activation of the presynaptic muscarinic receptors by the agonist oxotremorine (50 mumol/l) decreased the liberation of 3H-acetylcholine. The muscarinic antagonist atropine (1 mumol/l) abolished the inhibitory effect of oxotremorine and by itself increased the evoked release of the newly formed 3H-acetylcholine. Adenosine (50 mumol/l) reduced the evoked release of radioactivity. Theophylline (30 mumol/l) prevented the inhibitory effect of adenosine and itself enhanced the release. Xylazine (1 mumol/l), an alpha 2-adrenoceptor agonist did not affect the release. It is concluded that the stimulation-evoked release of 3H-acetylcholine from the mouse phrenic nerve hemidiaphragm preparation preloaded with 3H-choline is derived from the motor nerves. The release of acetylcholine is modulated by activation of presynaptic muscarinic and adenosine receptors.

Effect of mono- and diaminopyridines on release of [3H]norepinephrine from isolated guinea-pig atrium

Neurochemical evidence has been obtained that 4-aminopyridine, 3,4-diaminopyridine and 3,3-dimethyl-1-(4-amino-3-pyridyl)urea HBr (LF-14), concentration-dependently enhanced the stimulation-evoked release of [3H]norepinephrine ([3H]NE) from isolated guinea-pig atrium. The effects of aminopyridines, compounds known to inhibit potassium channels, were Ca0-dependent. High pressure liquid chromatography, combined with radiochemical detection, indicated that the increased stimulated release of radioactivity was due to [3H]NE. Since the aminopyridines studied also enhanced the release of [3H]NE from atrium treated with cocaine, a blocker of uptake1, it seems likely that the increased release of NE caused by the aminopyridines is due to the enhanced release of NE from sympathetic axon terminals and not to the inhibition of reuptake. It is probable that the sympathomimetic cardiac effects (positive inotropic and chronotropic effect) of aminopyridines observed in animal experiments is due to the increased release of NE, caused by these compounds.

Natural killer activity in patients with chronic hepatitis treated with OK432, interferon, adenine arabinoside and glycyrrhizin

Natural killer (NK) activity in the peripheral blood of patients with chronic liver disease was measured using 51Cr labeled K562 cells as target cells. NK activity was elevated but not significantly in patients with chronic hepatitis compared with healthy controls and significantly lower in the patients with hepatocellular carcinoma. The activity decreased in the order of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Although the level of NK activity in patients with chronic hepatitis did not correlate with the level of alanine aminotransferase (ALT), it tended to be elevated in association with elevation of ALT in patients treated with OK432, interferon-beta, glycyrrhizin or adenine arabinoside. In chronic liver disease, phytohemagglutinin (PHA) skin test showed a positive correlation with NK activity. In all patients who were treated with the immunopotentiator, OK432, and whose HBeAg became negative, NK activity was elevated during the treatment. These results suggest that the NK activity in peripheral blood may be related to hepatocytic injury even if this is not the effector mechanism of the injury.

Role of endogenous gastric mucosal prostaglandins in the formation of acute gastric mucosal lesions induced by aspirin, ethanol, HCl and CH3COOH

The role of endogenous mucosal prostaglandins (PGs) in the production of acute gastric mucosal lesions (AGML) was examined in rats. Aspirin, ethanol or 0.6 N-HCl was given intragastrically and 20% acetic acid was injected into the gastric wall. Endogenous gastric mucosal PG (A + B), PGE and PGF were determined by radioimmunoassay. Their gastric contents were markedly reduced by aspirin administration (p less than 0.001). The level of gastric mucosal PGs still remained low (p less than 0.001) after the aspirin-induced AGML began to heal. Furthermore, rats with AGML induced by ethanol, HCl or acetic acid, showed no decrease in endogenous gastric mucosal PGs compared with the controls. These findings indicated that endogenous PGs are not necessary for either the induction or healing of experimental AGML.

Myocardial oxygen metabolism of the right ventricle with volume loading and hypoperfusion

A comparison of blood flow and myocardial O2 consumption (MVO2) in the right and the left ventricles was made in dogs whose chests had been opened. The effect of volume loading by arterio-venous and arterio-left atrial shunts, and the effect of ventricular hypoperfusion by rapid removal of blood were examined in the presence and absence of the pericardium. Blood flow per unit myocardium was greater in the left anterior descending coronary artery (LAD) than in the right coronary artery (RCA), 75 +/- 4.3 vs. 46 +/- 2.8 (mean +/- SE) ml/min per 100g, respectively. Similarly, the myocardial O2 extraction ratio (EO2) was 59 +/- 2% in the left ventricle and 43 +/- 3% in the right ventricle (p less than 0.001). The MVO2 was greater for the left than for the right ventricle, 8.0 +/- 0.6 vs. 3.5 +/- 0.3 ml O2/min per 100g. Volume loading to both ventricles by arterio-venous (AV) shunt increased MVO2 of the right ventricle by augmented EO2 in addition to a rise in the coronary arterial blood flow. Decrease in aortic pressure by rapid removal of blood increased EO2 in both ventricles. The increments of EO2 were greater in the right ventricle than in the left ventricle, 54 vs. 31% (p less than 0.01). When the pericardium was closed with suture, right and left end-diastolic pressure rose, but EO2 and coronary blood flow of both ventricles did not change. We conclude that reserve capacity of myocardial O2 extraction was greater in the right ventricle than in the left ventricle.

The effect of cardiac sympathetic nerve stimulation on the right ventricle in canine heart

The change in coronary hemodynamics during right or left cardiac sympathetic nerve stimulation was studied in anesthetized open chest dogs. No difference in the increasing rate of mean coronary blood flow between right coronary artery (RCA) and left anterior descending coronary artery (LAD) was observed. However the increasing rate of right ventricular systolic pressure X heart rate (RVSP X HR) was greater than that of left ventricle (LV). With phentolamine injection, cardiac sympathetic nerve stimulation showed similar changes as the controls. Beta-stimulation by isoproterenol infusion did not cause different effects on the increasing rate of coronary blood flow between RCA and LAD. These results showed that cardiac sympathetic nerve stimulation increased the double product of the right ventricle (RV) more than that of the LV and the increase was not affected by phentolamine. Moreover, cardiac sympathetic nerve stimulation, either the right or the left, caused the greater effects on the RV compared to the LV mainly through beta-adrenoceptors, and that the response of the RV to increase in oxygen demand was possibly, in part, different from that of the LV.

Ricinus communis agglutinin II-reactive glycoproteins from the ascites of patients with hepatocellular carcinoma and their use in enzyme-linked immunosorbent assay

Ricinus communis agglutinin II-reactive glycoproteins from the ascites of patients with hepatocellular carcinoma were prepared using lectin affinity chromatography. Normal serum- and cirrhotic ascites-components were removed by columns with immobilized antibodies against them. Ricinus communis agglutinin II-reactive glycoproteins thus obtained were supposed to be hepatocellular carcinoma-associated and less than 0.1% of the protein in the starting material. Polyacrylamide gel electrophoresis of these glycoproteins revealed more than 10 major polypeptides with molecular weights ranging from 20K to 200K daltons. The rabbit antiserum raised against them reacted with at least three components of 45, 52 and 55K daltons. The serum level of this antibody-reactive glycoproteins was assessed by an enzyme-linked immunosorbent assay. It was elevated in 91% of cases of hepatocellular carcinoma, 70% of cases of other gastrointestinal carcinoma, 88% of cases of liver cirrhosis, 55% of cases of chronic hepatitis, and 25% of cases of acute hepatitis. The mean value of hepatocellular carcinoma was significantly greater than those of other groups. These results suggest that some of Ricinus communis agglutinin II-reactive glycoproteins in hepatocellular carcinoma patients may be cancer-associated glycoproteins and that their serum levels are increased in hepatocellular carcinoma patients.

Application of 3 alpha-hydroxysteroid dehydrogenase column to the determination of bile acids fractionated by high-performance liquid chromatography: advantage of pretreating human bile acids with Seppak C18 and piperidinohydroxypropyl Sephadex LH-20

The analysis of bile acids in human bile was tried by high-performance liquid chromatography (HPLC). Bile acids in human bile were first prefractionated into free, glycine- and taurine-conjugated bile acids using a Seppak C18 cartridge and a piperidinohydroxypropyl Sephadex LH-20 (PHP-LH-20) column. Each fraction was then processed through a HPLC system consisting of a Zorbax ODS column and a 3 alpha-hydroxysteroid dehydrogenase (3 alpha-HSD) column. By these procedures the major 15 bile acids were clearly separated, and each bile acid of 10-125 ng was accurately analyzed. More than 400 times of analysis could be repeated on one 3 alpha-HSD column without loss of sensitivity. Thus the pretreatment through Seppak C18 and PHP-LH-20 made the HPLC analysis of human bile acids accurate and applicable to clinically obtained materials.

In vitro interferon producing activity of peripheral mononuclear cells in patients with chronic liver disease

Interferon-gamma (IFN-gamma) was induced from a human peripheral mononuclear fraction by incubation with a streptococcal preparation stabilized with penicillin G (OK432). This IFN-gamma-producing activity was significantly reduced in patients with chronic hepatitis and hepatocellular carcinoma. In patients with liver cirrhosis it was also reduced but not significantly. Serum hepatitis B virus DNA and skin tests for the purified protein derivative of tuberculin, phytohemagglutinin-P and a polysaccharide fraction prepared from streptococcus pyogenes Su strain were determined to have no significant relation to this IFN-gamma-producing activity. Although the addition of interleukin 2 (IL-2) to the culture medium enhanced the IFN-gamma-producing activity, there was no difference in this enhancement between normal control and chronic hepatitis. Therefore reduction of the IFN-gamma-producing activity observed in chronic hepatitis seems to be caused by a decreased number of IFN-gamma-producing activity cells or hypofunction of these cells or both. Since HBeAg became negative in patients whose IFN-gamma-producing activity was increased by the administration of the immunopotentiator OK432 or IFN-beta, the IFN-producing system in the patients with B type hepatitis may contribute to the elimination of HBV. Adenine arabinoside suppressed IFN-gamma-producing activity both in vivo and in vitro.

Immunohistochemical study of fibronectin, lysozyme, and alpha-fetoprotein (AFP) in human hepatocellular carcinoma

We have immunohistochemically localized fibronectin, lysozyme and alpha-fetoprotein (AFP) in 21 human hepatocellular carcinoma (HCC) tissues obtained by surgical resection at both light and electron microscopic levels. Three distinct distribution patterns of fibronectin (sinusoidal, periacinar, and pericellular patterns) were observed. The sinusoidal and periacinar patterns were mainly observed in HCC of pseudoglandular or trabecular patterns and of Edmondson's grade I or II, whereas the pericellular pattern was observed in HCC of compact or trabecular patterns and of Edmondson's III grade, suggesting that the pericellular fibronectin was rather associated with undifferentiated HCC. Electron microscopic observation of the pericellular fibronectin showed fibronectin to be present in the dilated intercellular spaces where microvilli were moderately developed. We observed intracytoplasmic staining of fibronectin in 2 of the 21 HCC cases. By immunoelectron microscopy, fibronectin was observed in the endoplasmic reticulum (ER) of some HCC cells. In the 21 HCC cases, lysozyme-positive cancer cells were observed in 10 cases, and AFP in 6 cases. At the ultrastructural level, lysozyme was identified in the ER and the perinuclear spaces of HCC cells, suggesting that lysozyme was synthesized by these cells. Lysozyme-positive cases tended to be more frequently observed in cases with the pericellular pattern of fibronectin rather than those with sinusoidal or periacinar patterns.