Dilatation of sealed Dacron vascular prostheses: a comparison of Gelseal and Hemashield

OBJECTIVE

Early postoperative dilation of a gelatin-impregnated knitted dacron prosthesis (Gelseal, Vascutek) and a collagen-impregnated woven Dacron prosthesis (Hemashield, Meadox Medicals) was studied.

EXPERIMENTAL DESIGN

Prospective study.

SETTING

Institutional clinical research.

MATERIALS AND METHODS

A total of 30 patients who underwent aortic repair for abdominal aortic aneurysm with a Gelseal (n=15) or Hemashield (n=15) were studied. Prior to and immediately following implantation, the diameter of each graft was measured with slide calipers. The external diameter was examined by CT scan 4 weeks after surgery. Early dilation of Gelseal and Hemashield was estimated and compared.

RESULTS

Prior to implantation, the external diameter of the Gelseal and Hemashield was 120% and 113% of the package size (PS), respectively, while the internal diameter was 103% and 102% of the PS, respectively. Following implantation, the external diameter of the Gelseal and Hemashield was 122% and 113% (immediately after) and 129% and 118% (4 weeks later) of the PS, respectively.

CONCLUSIONS

The actual dilation rate for the first 4 weeks after implantation was estimated as 8% with the Gelseal and 4% with the Hemashield.

[Successful chemotherapy based on in vitro chemosensitivity testing in a case of recurrent thymic carcinoma]

A 71-year-old woman underwent radical resection in May 1994 for a mediastinal mass invading the anterior chest wall. Histopathological examination revealed adenosquamous cell carcinoma. She was treated with postoperative chemotherapy including 5-fluorouracil (5-FU) and 4'-D-tetrahydropyrayl-doxorubicin (THP), based on in vitro chemosensitivity testing (CST), by MTT assay, using a surgical specimen. In December 1994, a recurrent tumor was detected on the left anterior chest wall and the patient received two courses of 5-FU, THP and methotrexate (MTX). The size of the chest-wall tumor decreased 25%. In July 1995, the patient had involvement of the left axillary lymph node and brain metastases in addition to the mass on the chest wall. Therefore, cisplatin, 5-FU and MTX were selected as treatment agents, based on CST using a metastatic axillary lymph node. After two courses of these agents, chest computed tomography showed a 91% reduction in the size of the chest wall tumor. Radiation was administered for the brain metastasis. In March 1997, the patient died of thymic carcinoma.

Change in chemosensitivity of DMBA-induced rat mammary tumor after oophorectomy

BACKGROUND

A combination of chemotherapy and endocrine therapy is usually employed for the treatment of breast cancer, but the optimal order of this combination has not yet been verified. To determine the appropriate order of this combination, changes in chemosensitivity to anticancer agents after endocrine therapy were examined.

MATERIALS AND METHODS

Rat mammary tumors induced by 7,12-dimethylbenz[alpha]-anthracene (DMBA) were used. Chemosensitivity tests were performed before and 3 weeks after bilateral oophorectomy. The MTT assay was used to test eight anticancer agents, and oophorectomy was performed as the endocrine therapy.

RESULTS

DMBA-induced rat mammary tumors showed sensitivity to 4'-0-tetrahydropyranyl-doxorubicin, 5-fluorouracil, peplomycin, mitomycin C, and methotrexate. Chemosensitivity to these agents seemed to be somewhat reduced after oophorectomy compared with before the operation, but the difference was not significant.

CONCLUSION

The influence of oophorectomy on chemosensitivity of DMBA-induced mammary tumor is thought to be minimal.

Asymmetrical changes in the fodrin alpha subunit in the superior temporal cortices in schizophrenia

BACKGROUND

We examined possible abnormalities in neural structural proteins that may underlie morphometric changes reported in the left superior temporal cortices (Brodmann's area 22) of schizophrenics.

METHODS

Particulate proteins of the superior temporal cortices taken at autopsy from 11 schizophrenic and 9 control brains were fractionated by gel electrophoresis. Target proteins, identified by reading their amino acid sequences, were immunoquantified using the specific antibody.

RESULTS

Amino acid sequences of the 150-kDa proteins on sodium dodecyl sulfate/polyacrylamide gel electrophoresis, which were significantly increased on the left side of schizophrenic superior temporal cortices, revealed that they were proteolytic fragments of the alpha subunit of fodrin, a major cytoskeletal protein underlying the plasma membrane. Immunoquantification using the specific antibodies against alpha and beta subunits of fodrin indicated that there exist concomitant decreases in the full-length 240-kDa form and increases in the 150-kDa form of alpha-fodrin with no changes of the 235-kDa form of beta-fodrin in the left superior temporal cortices of the schizophrenic brains.

CONCLUSIONS

The findings may be a possible molecular basis for linking morphometric changes to neurochemical pathophysiology in schizophrenia.

Efficacy of preconditioning with N-acetylcysteine against reperfusion injury after prolonged cold ischaemia in rats liver in which glutathione had been reduced by buthionine sulphoximine

OBJECTIVE

To investigate the ability of N-acetylcysteine (NAC) to prevent cold ischaemic-reperfusion injury and improve hepatic integrity in a glutathione-depleted condition.

DESIGN

Open laboratory study.

SETTING

University hospitals, Japan and France.

MATERIALS

40 male Wistar rats.

INTERVENTIONS

To produce a glutathione-depleted liver, buthionine sulphoximine (BSO) was injected intraperitoneally 2 hours before either NAC or 5% dextrose was infused 15 minutes before the liver was harvested. We used an isolated perfused rat liver model that had undergone prolonged hypothermic ischaemia, cold-storage for 48 hours and reperfusion for 120 minutes.

MAIN OUTCOME MEASURES

Concentrations of hepatic enzymes released into samples of perfusate, concentration of adenosine triphosphate in liver tissue, concentrations of reduced and oxidized glutathione in perfusate, and bile production.

RESULTS

The concentrations of the hepatocellular enzymes and oxidised glutathione in the perfusate samples were significantly reduced in the NAC group compared with the 5% dextrose group. Bile production improved significantly in the NAC group compared with the 5% dextrose group. The concentration of reduced glutathione in liver tissue was not increased by NAC.

CONCLUSION

In a glutathione-depleted liver NAC prevented hepatic injury and improved liver integrity after a cold ischaemic-reperfusion injury, by acting not as a substrate for glutathione synthesis but as a direct free radical scavenger.

[Clinical benefits of normothermic cardiopulmonary bypass on postoperative systemic metabolism]

To evaluate the influence of body temperature during cardiopulmonary bypass (CPB) on postoperative systemic metabolism, 32 patients undergoing elective cardiac surgery were randomly assigned to either hypothermia (n = 16) or normothermia (n = 16). Serial hemodynamic parameters and blood samples were obtained after surgery. CPB and operation times were significantly shorter and the platelet reduction ratio during CPB [ = (platelets before CPB-platelets after CPB)/platelets before CPB] was significantly lower in normothermic patients than in hypothermic patients. The platelet reduction ratio was dependent on the minimum rectal temperature during CPB, the operation time, and the CPB time. In the early postoperative period, hypothermic patients had abnormally high systemic vascular resistance and a reduced cardiac index compared with the normothermic patients. There were no differences between 2 groups in postoperative hepatic and renal functions, changes in oxygen consumption, arterial-venous PCO2 or arterial-venous pH gradient. This study suggested a beneficial influence of normothermic CPB on postoperative hemodynamics. Normothermic CPB was not associated with adverse effects on postoperative metabolic recovery.

Immunohistochemical colocalization of serotonin, substance P and Met-enkephalin-Arg6-Gly7-Leu8 in the endocrine cells of the ruminant duodenum

The duodenum of various ruminants was examined by immunohistochemical staining for serotonin, substance P and Metenkephalin-Arg6-Gly7-Leu8 (MENK8). Serotonin- and substance P-immunoreactive endocrine cells were detected in samples from cow, calf, sheep, goat, and barbary sheep, MENK8-immunoreactive endocrine cells were detected exclusively in samples from cow and calf. Substance P and MENK8 immunoreactivity was found in serotonin-immunoreactive endocrine cells of cattle. Substance P- and MENK8-immunoreactive nervous elements were detected in all ruminants examined. The present results suggest that the expression and/or the mechanism that controls the expression of each peptide might differ between endocrine cells and nerve cells and might also depend on animal species.

Three-dimensional development of bovine reticular cell (Cellula reticuli)

This paper describes the three-dimensional construction of the reticular cell, cellula reticuli, in bovine reticulum and its ontogenetic development. Reticular cells of fetal suckling calf and adult tissues were investigated both at the surface of intact mucosa and macerated samples using scanning electron microscopy. At the third month of gestation, the formation of the reticular cells on the mucosal surface started from the center of the cell and just above the reticular crest. The reticular crests were observed on the surface of the macerated sample at an earlier period of gestation (third month). In the eighth month of gestation, primary, secondary and tertiary reticular crests and papillae could be observed from the mucosal surface. Macerated samples showed that those structures were already formed completely under the epithelium by the first half of the seventh month of gestation. It is suggested that the development of the reticular papillae starts from the lower to the upper parts of the reticular cell.

Isotype-specific G protein abnormalities in the left superior temporal cortex and limbic structures of patients with chronic schizophrenia

BACKGROUND

The potential role of signal transducing guanine nucleotide-binding regulatory protein (G protein) in schizophrenia is largely unknown.

METHODS

We immunoquantified isotypes of G protein using specific antisera against alpha and beta subunits of G protein in the superior temporal, prefrontal, and entorhinal cortices as well as the nucleus accumbens and amygdala of postmortem brains from 19 schizophrenic and 28 control subjects.

RESULTS

In the left hemisphere of schizophrenics, the amount of Gi alpha, Go alpha, and Gq alpha but not that of Gs alpha or G beta decreased in the superior temporal cortex by 27%, 27%, and 16%, respectively, as compared with the values in ipsilateral controls; the amount of any G protein isotype in the prefrontal and entorhinal cortices was not changed. In the nucleus accumbens and amygdala, the paranoid type schizophrenics showed a smaller amount of Gi alpha and Go alpha than the disorganized type schizophrenics. In the right superior temporal cortex, the isotype amount did not differ between the schizophrenic and control groups.

CONCLUSIONS

The decreased Gq alpha immunoreactivity in the schizophrenic left superior temporal cortex may reflect the down-regulation of Gq alpha, resulting from chronic stimulation of Gq alpha-coupled receptors, while the decreased Gi alpha and Go alpha in the nucleus accumbens and amygdala of paranoid type schizophrenics may be related to the dopaminergic hyperactivity via dopamine D2 receptors.

Purification and cloning of hepatocyte growth factor activator inhibitor type 2, a Kunitz-type serine protease inhibitor

Hepatocyte growth factor (HGF) activator is a serine protease responsible for proteolytic activation of HGF in response to tissue injury and thus plays an important role in the regulation of biological functions of HGF in regenerating tissue. We previously purified an inhibitor of HGF activator (HGF activator inhibitor type 1, HAI-1) from the conditioned medium of a human stomach carcinoma cell line MKN45 and cloned its cDNA. HAI-1 is a novel member of the Kunitz family of serine protease inhibitors. In the present study, we purified a second type of HGF activator inhibitor (HAI-2) from the conditioned medium of MKN45 cells and molecularly cloned its cDNA. The cDNA sequence revealed that HAI-2 is derived from a precursor protein of 252 amino acids and contains two Kunitz domains, indicating that HAI-2 is also a member of the Kunitz family of serine protease inhibitors. The primary translation product of HAI-2 has a hydrophobic sequence in the COOH-terminal region, suggesting that, like HAI-1, HAI-2 is produced in a membrane-associated form and secreted in a proteolytically truncated form. Because HAI-2 and HAI-1 are potent inhibitors specific for HGF activator, they may be involved in regulation of proteolytic activation of HGF in injured tissues.

The effects of N-acetylcysteine and anti-intercellular adhesion molecule-1 monoclonal antibody against ischemia-reperfusion injury of the rat steatotic liver produced by a choline-methionine-deficient diet

Abundant fat in the liver has been implicated in poor outcome after liver transplantation or liver surgery, but the reasons for this association are still unclear. The aim of the present study was to examine mechanisms that may be involved in hepatic dysfunction after ischemia-reperfusion (I/R) of the steatotic rat liver. Steatosis was produced by a choline-methionine-deficient (CMDD) diet. In the first experiment, isolated perfused rat livers, subjected to 24-hour cold storage followed by 120-minute reperfusion, were used to investigate hypothermic I/R injury of the steatotic rat liver. In the second experiment, livers were subjected to 60-minute partial left lobar vascular clamping to allow study of normothermic I/R injury. In the first experiment, compared with normal nonsteatotic liver, steatotic livers showed significantly greater injury, as assessed by amounts of hepatic enzymes released into the perfusate, bile production, the concentrations of reduced glutathione (GSH) in the perfusate, as well as in the livers themselves, and electron microscopic findings of sinusoidal microcirculatory injury. The addition of N-acetylcysteine (NAC), a precursor of glutathione, to the liver before cold storage significantly improved these parameters in steatotic livers. The second experiment showed that, compared with nonsteatotic livers, steatotic livers had lower concentrations of GSH and impaired rates of bile production. There was also evidence of increased oxidative stress in polymorphonuclear leukocytes (PMNLs) in liver or peripheral blood of rats with fatty livers. An anti-rat intercellular adhesion molecule-1 (ICAM-1) monoclonal antibody inhibited neutrophil infiltration into pericentral sinusoids and improved these parameters in the steatotic rats. We conclude that sinusoidal microcirculatory injury is involved in hypothermic I/R injury, that oxidative stress produced by PMNLs is involved in normothermic I/R injury, and that NAC and anti-rat ICAM-1 monoclonal antibody restore liver integrity in I/R injury.

Targeted vinblastine chemotherapy with two preparations of lipiodol contrast medium

BACKGROUND

Long-term survival and cure can not be achieved in patients with unresectable metastatic liver cancer. In this study, to improve the antitumor activity of oily anticancer agents, which enable targeted cancer chemotherapy, various concentrations of vinblastine dissolved in Lipiodol ultrafluid (vinblastine/Lipiodol U) or Lipiodol F, which has three times the viscosity of Lipiodol ultrafluid, were used.

MATERIALS AND METHODS

Rabbits bearing VX2 tumors measuring 1 to 2 cm in diameter in the liver received arterial injections of 0.2 ml of these drugs, and antitumor activity were examined.

RESULTS

Complete necrosis of the tumor was observed in three of nine rabbits received vinblastine/Lipiodol U at 2.5 mg/ml. Complete necrosis of the tumor was observed in all eleven rabbits which received vinblastine/Lipiodol U at 5 mg/ml. At concentrations of 7.5 and 10 mg/ml, the necrotic area spread from the tumor to the liver parenchyma surrounding the tumor. The antitumor activity of vinblastine dissolved in Lipiodol F was increased compared with that of vinblastine dissolved in Lipiodol ultrafluid.

CONCLUSIONS

The antitumor activity of a kind of the oily anticancer agents, vinblastine/Lipiodol increased with increasing amounts of vinblastine dissolved in Lipiodol ultrafluid and with the increasing viscosity of the carrier, Lipiodol.

Hrs, a tyrosine kinase substrate with a conserved double zinc finger domain, is localized to the cytoplasmic surface of early endosomes

Hrs is a 115-kDa double zinc finger protein that is rapidly tyrosine phosphorylated in growth factor-stimulated cells. However, its function remains unknown. Here we show that Hrs is localized to early endosomes. Intracellular localization of endogenous Hrs and exogenously expressed Hrs tagged with the hemagglutinin epitope was examined by immunofluorescence staining using anti-Hrs and anti-hemagglutinin epitope antibodies, respectively. Hrs was detected in vesicular structures and was colocalized with the transferrin receptor, a marker for early endosomes, but only partially with CD63, a marker for late endosomes. A zinc finger domain deletion mutant of Hrs was also colocalized with the transferrin receptor, suggesting that the zinc finger domain is not required for its correct localization. Immunoelectron microscopy showed that Hrs was localized to the cytoplasmic surface of these structures. By subcellular fractionation, Hrs was recovered both in the cytoplasmic and membrane fractions. The membrane-associated Hrs was extracted from the membrane by alkali treatment, suggesting that it is peripherally associated with early endosomes. These results, together with our finding that Hrs is homologous to Vps27p, a protein essential for protein traffic through a prevacuolar compartment in yeast, suggest that Hrs is involved in vesicular transport through early endosomes.

Stimulation of liver regeneration and function after partial hepatectomy in cirrhotic rats by continuous infusion of recombinant human hepatocyte growth factor

BACKGROUND/AIMS

Radical resection is accepted as one of the most curative treatments for hepatocellular carcinoma. However, most patients have coexisting cirrhosis and their liver function is usually impaired. It is therefore important to stimulate the regeneration and function of the remnant cirrhotic liver after hepatectomy. Hepatocyte growth factor is a potent mitogen that has been suggested to play a crucial role in liver regeneration.

METHODS

In this study, we performed 45% hepatectomy in rats with cirrhosis induced by thioacetamide, and administered recombinant human hepatocyte growth factor (rhHGF) with dextran sulfate by continuous infusion into the jugular vein with an infusion pump.

RESULTS

rhHGF stimulated an increase in the wet weight of the remnant liver compared with untreated control rats. The proliferating cell nuclear antigen labeling index showed that this increase resulted from the stimulation of DNA synthesis. Serum levels of liver enzymes increased after hepatectomy, but returned to the prehepatectomy level more rapidly in rhHGF-treated rats than in controls. rhHGF increased hepatic protein synthesis above prehepatectomy levels and also markedly increased the serum levels of hepatic lipid metabolites.

CONCLUSIONS

These results demonstrate that continuous intravenous infusion of rhHGF enhances the growth and function of the remnant liver in rats with cirrhosis after partial hepatectomy. Therefore, rhHGF may be useful after hepatic resection in patients with cirrhosis.

Cysteine-S-conjugate beta-lyase activity and pyridoxal phosphate binding site of onion alliin lyase

Purification of onion alliin lyase gave two fractions by cation exchange chromatography. Both fractions showed the comparable high catalytic activity of cysteine-S-conjugate beta-lyase with that of alliin lyase using S-(2-chloro-6-nitrophenyl)-L-cysteine and alliin, S-allyl-L-cysteine sulfoxide as substrates. All the active substrates tested with onion alliin lyase were also active to the cysteine-S-conjugate beta-lyase of Mucor javanicus, but the catalytic activity of the Mucor enzyme was lower for all the substrates. The pyridoxal phosphate binding site of the onion alliin lyase was identified as Lys 285 in the amino acid sequence deduced from cDNA which has been reported. This lysine was conserved in all the sequences from the alliin lyase cDNAs, while similarity was not found between the sequences around pyridoxal phosphate binding sites of both the onion alliin lyase and the Mucor cysteine-S-conjugate beta-lyase.

Acute aortic dissection without intimal tear

A case of acute aortic dissection without intimal tear is reported. A 68-year-old woman with acute onset of Stanford type-B aortic dissection was admitted. Because of progressive anemia and pleural leakage, an operation was performed. False lumen of the descending thoracic aorta was occupied with fresh hematoma, but no sign of an intimal defect was found. Although aortic dissection without intimal tear has been reported via angiography, CT scan, MRI, and autopsy, surgically confirmed cases of this type of dissection have been rarely reported.

Measurement of intracellular Na+ concentration by a Na+-sensitive fluorescent dye, sodium-binding benzofuran isophthalate, in porcine adrenal chromaffin cells--usage of palytoxin as a Na+ ionophore

Palytoxin was found to equilibrate sodium ions (Na+) across the cell membrane much faster than dose gramicidin, which has been frequently used to calibrate the intracellular Na+ concentration ([Na+]in), in cells treated with a Na+-sensitive fluorescent dye, sodium-binding benzofuran isophthalate (SBFI). Palytoxin was capable of equilibrating Na+ in cells treated with SBFI-acetoxymethyl ester (SBFI-AM) and in voltage-clamped cells loaded with SBFI through a patch pipette. Nicotine caused a dose-dependent increase in ([Na+]in) in porcine adrenal chromaffin cells treated with SBFI-AM and caused a simultaneous increase in [Na+]in and inward current in the voltage-clamped cells loaded with SBFI. Palytoxin has an advantage of calibrating ([Na+]in) in a shorter time than dose gramicidin because of its powerful ionophoretic activity.

Postoperative inflammatory reactions to sealed Dracon prostheses: a comparison of Gelseal and Hemashield

OBJECTIVE

The purpose of this study was to assess and compare inflammatory reactions to two types of sealed vascular prostheses used in the repair of abdominal aortic aneurysm.

EXPERIMENTAL DESIGN

Randomized prospective study with a follow-up period of 21 days.

SETTING

University hospital study.

PATIENTS

Sixty patients admitted for elective abdominal aortic aneurysm repair.

INTERVENTION

Each patient underwent repair of abdominal aortic aneurysm with either a gelatin-sealed knitted Dacron prosthesis (Gelseal, Vascutek, n = 30) or a collagen-sealed woven Dacron prosthesis (Hemashield, Meadox Medicals, n = 30).

MEASURES

As indicators of the presence of inflammation, the peripheral blood cell count, platelet count, and plasma C-reactive protein (CRP) concentration were determined in each patient on postoperative days (PODs) 1, 7, 14 and 21. Body temperature was measured every 8 hours.

RESULTS

Patients in both groups revealed a low-grade fever and leukocytosis during the first 7 PODs. Significantly higher leukocyte counts were demonstrated in the Gelseal group on PODs 7 and 14. However, no difference in the leukocyte count, CRP concentration, or body temperature existed between the two groups on POD 21. Biphasis changes in the platelet count were observed in both groups. No complications were encountered.

CONCLUSION

The Gelseal prosthesis was associated with higher inflammatory response during the second week following implantation, but this difference had resolved by POD 21. This finding may reflect an inflammatory reaction against impregnated gelatin.

Prediction of postoperative decompensated liver function by technetium-99m galactosyl-human serum albumin liver scintigraphy in patients with hepatocellular carcinoma complicating chronic liver disease

BACKGROUND

Preoperative technetium-99m galactosyl-human serum albumin (Tc-GSA) liver scintigraphy may predict postoperative decompensated liver function and its value has been investigated in patients having resection of hepatocellular carcinoma (HCC).

METHODS

Hepatic uptake ratio of Tc-GSA (LHL15) was measured before operation in 30 patients. Postoperative complications were analysed retrospectively and compared with LHL15 values and other indicators evaluating hepatic function.

RESULTS

The LHL15 of 22 patients without complications was 0.91 or more, compared with 0.90 or less in the eight patients who had complications. Multifactorial analyses showed that LHL15 and Child-Pugh grade significantly predicted postoperative complications (P < 0.0001 and P = 0.0111 respectively). LHL15 was a significant predictor of complications in patients with Child-Pugh grade B disease (n = 15, P = 0.0011).

CONCLUSION

LHL15 was a reliable preoperative indicator of the risk of major postoperative complications in patients who had resection for HCC.

Calcium channel subtypes in porcine adrenal chromaffin cells

The effects of nifedipine, omega-conotoxin GVIA (omega-CgTx) and omega-agatoxin IVA (omega-AgTx) on Ca2+ currents, a 60-mM-K+-induced increase in intracellular Ca2+ concentration (-Ca2+-i) and catecholamine secretion were examined to clarify the subtypes of Ca2+ channels in cultured adrenal chromaffin cells from the pig. Nifedipine, omega-CgTx, and omega-AgTx inhibited Ca2+ currents in a dose-dependent manner, suggesting the presence of L-, N- and P-type Ca2+ channels. The maximal doses of nifedipine (10 microM), omega-CgTx (1 microM), and omega-AgTx (0.1 microM) inhibited Ca2+ currents to 85%, 22%, and 94% of control currents, respectively. The inhibitory effects of these three blockers were observed in the same cell, indicating that at least three subtypes of Ca2+ channels are present in porcine chromaffin cells. The increase in -Ca2+-i and catecholamine secretion induced by 60 mM K+ were inhibited equally by nifedipine (10 microM) and omega-CgTx (1 microM), but not by omega-AgTx (0.1 microM). These results suggest that L-, N- and P-type Ca2+ channels are present in porcine adrenal chromaffin cells, and that the major pathways of Ca2+ entry evoked by a high concentration of K+ are L- and N-type Ca2+ channels.

[Susceptibilities of bacteria isolated from patients with respiratory infectious diseases to antibiotics (1995)]

The bacteria isolated from the patients with lower respiratory tract infections were collected by institutions located throughout Japan, since 1981. Ikemoto et al. have been investigating susceptibilities of these isolates to various antibacterial agents and antibiotics, and characteristics of the patients and isolates from them each year. Results obtained from these investigations are discussed. In 23 institutions around the entire Japan, 567 strains of presumably etiological bacteria were isolated mainly from the sputa of 459 patients with lower respiratory tract infections during the period from October 1995 to September 1996. MICs of various antibacterial agents and antibiotics were determined against 74 strains of Staphylococcus aureus, 82 strains of Streptococcus pneumoniae, 104 strains of Haemophilus influenzae, 85 strains of Pseudomonas aeruginosa (non-mucoid strains), 18 strains of Pseudomonas aeruginosa (mucoid strains), 52 strains of Moraxella subgenus Branhamella catarrhalis, 25 strains of Klebsiella pneumoniae etc., and the drug susceptibilities of these strains were assessed except for those strains that died during transportation. 1) S. aureus. S. aureus strains for which MICs of oxacillin (MPIPC) were higher than 4 micrograms/ml (methicillin-resistant S. aureus) accounted for 52.7%. Arbekacin (ABK) showed the most highest activity against S. aureus with MIC80 of 0.5 micrograms/ml. Vancomycin (VCM) showed the next highest activity with MIC80 of 1 microgram/ml. These drugs showed the high activities against MRSA with MIC80S of 1 microgram/ml. 2) S. pneumoniae. Most of drugs tested showed potent activities against S. pneumoniae. Imipenem (IPM) and panipenem (PAPM), carbapenems, showed the most potent activity with MIC80S of 0.063 microgram/ml. Cefotaxime (CTX), cefmenoxime (CMX) and cefpirome (CPR) of cephems showed the next most potent activities with MIC80S of 0.25 microgram/ml. Erythromycin (EM) and clindamycin (CLDM) showed low activities with MIC80S 128 micrograms/ml or high. Among these strains, however, 48.8% and 65.9% of respective strains were quite toward sensitive these agents with MICs of 0.063 microgram/ml. 3) H. influenzae. The activities of all drugs were potent against H. influenzae test with all MICs at 4 micrograms/ml or below. Cefotiam (CTM), CMX, cefditoren (CDTR) and ofloxacin (OFLX) showed the most potent activity with MIC90S to 0.063 microgram/ml. 4) P. aeruginosa. (mucoid strains) IPM and tobramycin (TOB) showed the most potent activity against P. aeruginosa (mucoid strains) with MIC80S of 1 microgram/ml. Ceftazidime (CAZ), cefsulodin (CFS) and carumonam (CRMN) showed next potent activity, with MIC80S of 2 micrograms/ml. The MIC80S of the other drugs ranged from 4 micrograms/ml to 32 micrograms/ml. 5) P. aeruginosa (non-mucoid strains). TOB and ciprofloxacin (CPFX) showed the most potent activities against P. aeruginosa (non-mucoid strains) with MIC80S of 1 microgram/ml. The MIC80 of ampicillin (ABPC) was 128 micrograms/ml in 1994, it was 16 micrograms/ml in 1995. 6) K. pneumoniae. All drugs except ABPC were active against K. pneumoniae. CPR and CRMN showed the most potent activities against K. pneumoniae with MIC80S of 0.063 microgram/ml. The MIC80S of the other drugs ranged from 0.125 microgram/ml to 2 micrograms/ml. 7) M. (B.) catarrhalis. Against M. (B.) catarrhalis, all the drugs showed good activities with MIC80S at 4 micrograms/ml or below. And MICs of all strains were 8 micrograms/ml or below. IPM, OFLX and minocycline (MINO) showed the most potent activity with MIC80S of 0.063 microgram/ml. Also, we investigated year to year changes in the characteristics of patients, their respiratory infectious diseases, and the etiology. Patients' backgrounds were examine for 567 isolates from 459 cases. The examination of age distribution found that the proportion of patients with ages over 60 years was 66.3% of all the patients showing a slight increase over that in 1994. Proportion of differe

[Arterial-venous carbon dioxide tension difference after hypothermic cardiopulmonary bypass]

Arterial-venous carbon dioxide tension difference (Pv-aCO2) is known to become high after severe hemorrhage shock and resuscitation. We hypothesized that Pv-aCO2 might be high after cardiac surgery because of the oxygen debt occurred during hypothermic cardiopulmonary bypass (CPB). Blood pressure, cardiac index, hemoglobin, the arterial and mixed venous blood gases were repeatedly measured every 6 hours for 24 hours following cardiac surgery in 60 adult patients who underwent hypothermic CPB. Immediately after the surgery, Pv-aCO2 was extremely high, then gradually decreased to within normal ranges 12 hours later (8.0 +/- 2.9 mmHg vs 5.9 +/- 3.1 mmHg. p < 0.01). Factors which significantly correlated to Pv-aCO2 were cardiac index, oxygen delivery, minimum rectal temperature and duration of CPB. Oxygen debt during hypothermic CPB might cause significantly high Pv-aDO2. At least 12 hours were necessary to recover from anaerobic status to physiological condition.