The influence of ageing on cisplatin pharmacokinetics in lung cancer patients with normal organ function

This study was performed to identify any relationship between age and cisplatin (CDDP) pharmacokinetics in lung cancer patients. CDDP was given at a dose of 80 mg/m2 by 1-h intravenous infusion to 23 lung cancer patients. All patients had normal renal, hepatic, and bone marrow functions. We measured ultrafilterable platinum (U-Pt) and total plasma platinum (T-Pt) using atomic absorption spectrometry. There was significant correlation between the age of the patients and U-Pt pharmacokinetic parameters such as the area under the plasma concentration versus time curve (AUC), total clearance (Cl), and peak plasma concentration (Cmax) as well as the AUC of T-Pt (P < 0.05). We performed univariate regression analysis to examine the influence of factors aside from age on the AUC of U-Pt and T-Pt. Creatinine and GPT levels were significantly related to the AUC of U-Pt, and creatinine clearance and creatinine concentrations were significantly related to the AUC of T-Pt. Therefore, stepwise multiple-regression models for the AUC of U-Pt and T-Pt were developed to assess an age effect. Age was consistently an independent and significant predictor of the AUC of U-Pt and T-Pt.

Tumor-associated Fever in Recurrent Breast Cancer with Liver Metastases

Of 67 patients with recurrent breast cancer accompanied by liver metastases admitted to our facility between January 1990 and August 1993, 8(12%) were found to have tumor-associated fever. We examined the characteristics of these patents. These patients had fever (over 38 degrees C) for more than one week. Their leukocyte counts did not exceed 10000/mm(3), and C-reactive protein (CRP) was below 5 mg/dl in 6 patients. ALL 8 patients had extensive liver metastases. Six patients had massive metastatic lesions, while the remaining 2 had diffuse metastases. Following systemic chemotherapy, 3 patients showed a reduction in tumor size and remission of fever; they remain alive at 14, 16 and 19 months after treatment. Of the remaining 5 patients who did not respond to systemic chemotherapy, 4 died within 6 months. The results of this study suggest that unexplained fever in patients with recurrent breast cancer is closely related to liver metastases.

Circulating fibroblast growth factor-like autoantibodies in two patients with multiple endocrine neoplasia type 1 and prolactinoma

Basic fibroblast growth factor (bFGF) is a potent endothelial cell mitogen found in a variety of normal and tumor tissues. bFGF lacks a classical amino-terminal signal sequence and is not readily detectable in plasma from normal subjects. In earlier studies we showed increased bFGF-like mitogenic activity for parathyroid-derived endothelial cells and (increased) bFGF immunoreactivity (0.24-1.28 ng/mL) in plasma of subjects with multiple endocrine neoplasia type 1 (MEN-1). In the present study we examined the proliferative activity of MEN-1 and normal plasmas (applied to protein-A columns) in calf pulmonary artery endothelial cells. Protein-A-eluted activity in plasma from MEN-1 prolactinoma plasma exceeded activity from normal and MEN-1 nonprolactinoma plasma in three of eight MEN-1 subjects with untreated or recurrent prolactinoma. Protein-A-eluted active fractions from MEN-1 prolactinoma plasma had several properties of an immunoglobulin G, including affinity for antihuman immunoglobulin G (IgG) agarose, sensitivity to thiols, and (prepared by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions) apparent mol wt corresponding to those of the heavy and light chains of IgG. The IgG fraction of MEN-1 prolactinoma plasma had far more activity in endothelial cells than did optimal concentrations of known growth factors or conditioned medium from prolactinoma cells. Endothelial cell bioactivity in protein-A-eluted fractions from MEN-1 prolactinoma plasma was neutralized 70% by rabbit antibodies to intact bFGF. These results imply novel growth stimulatory bFGF-like autoantibodies in a subset of MEN-1 patients with prolactinoma.

Urinary prolactin excretion in children with renal disease

The contribution of the kidney to the metabolism of prolactin has not yet been established. In the present study, urinary prolactin concentrations in 30 children with renal disease were measured by a newly devised, highly sensitive, time-resolved immunofluorometric assay. Median prolactin concentrations in the urine of children with renal disease, were 1.86 pmol/L-1 of urine (range: 0.17-546.31 pmol/L-1. By stepwise regression analysis, change in urinary prolactin levels as a function of the urinary beta 2-microglobulin concentrations was detected. These results indicate that prolactin urinary excretion in children with renal disease is dependent on the renal proximal tubular function.

Clinical significance of growth hormone-binding protein measurements in children

To investigate the role of growth hormone (GH) and its downstream axis in normal growth and growth disorders, we measured serum GH-binding protein (GHBP) levels in children by ligand-mediated immunofunctional assay (LIFA). Samples were taken from 512 healthy children of normal stature, 146 healthy neonates, 153 short but otherwise normal children, and 27 patients with GH deficiency. Serum GHBP showed no significant diurnal variation. Serum GHBP levels were low in neonates, acutely rose within 6 months, and gradually increased toward midpuberty in normal children (r = 0.2, P < 0.01, assessed among subjects over 1 year old). Neither significant sexual dimorphism nor rapid pubertal changes were observed. In normal short children and patients with GH deficiency, GHBP was lower than normal, but not significant. These data suggest that one of the etiologies for growth disorder in children could be resistance to, or low efficacy for, utilization of GH.

[The effects of diltiazem on neuromuscular transmission]

The effects of intravenous diltiazem (0.5 and 1.0 mg.kg-1) on muscle compound action potential (CAP) elicited from gastrocnemius muscle by sciatic nerve stimulation in cats were investigated. Analysis was performed on the amplitude of CAP, recovery curve (RC) and train-of-four ratio (TOFR). There was no response in any parameter after administering 0.5 mg.kg-1. On the other hand, diltiazem 1.0 mg.kg-1 produced significant depression only in the amplitude of CAP, but no change was observed in both RC and TOFR. It is concluded that approximately ten times the therapeutic dose of diltiazem is necessary to modify the neuromuscular transmission.

[Study of neuromuscular transmission with evoked electromyography--11. Comparison between blocks by magnesium and by pancuronium]

Effects of magnesium (Mg) on muscle compound action potentials (CAPs) which were elicited from gastrocunemius muscle by sciatic nerve stimulation in cats were studied, and the results were compared with those of alpha-bungarotoxin (alpha BuTX) and of non-depolarizing relaxants which had been reported previously. Recovery curves (RCs) of CAPs and train-of-four ratios (TOFR) as parameters of neuromuscular blockade were estimated during blocks by Mg as well as the methods described in the previous reports. The following results were obtained. 1) Neuromuscular blocks which were dependent on serum [Mg2+] were observed in accordance with cumulative dosages of MgSO4 solutions. 2) Recovery curves of CAPs showed a pattern which was characterized by extreme potentiations of test responses at shorter intervals of paired stimuli, followed by a slight depression at longer intervals than 500 msec. This pattern of RC was remarkably different from those after alpha BuTX and relaxants. 3) The mechanisms to produce these differences of RCs were discussed, and it is concluded that the notable depression of RCs derived from muscle relaxants may be caused by inhibitory effect on nerve terminals of relaxants which have different mechanism from that by Mg.

Increased basic fibroblast growth factor in plasma from multiple endocrine neoplasia type 1: relation to pituitary tumor

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by tumors of the parathyroids, pancreatic islets, and anterior pituitary. We previously reported a basic fibroblast growth factor (bFGF)-like substance in the plasma of subjects with MEN1. In the present study we used a novel sensitive specific 2-site immunoradiometric assay to test for bFGF in plasma. The assay employs immobilized affinity-purified N-terminal-specific anti-bFGF antibodies (antigen capture) and high affinity binding to radioiodinated heparin. bFGF-like immunoreactivity was undetectable (< 0.2 ng/mL) in normal subjects and in most unaffected relatives of MEN1 subjects. We found detectable bFGF ranging from 0.24-1.28 ng/mL in 21 of 50 subjects with MEN1. Seven of 8 MEN1 subjects with untreated pituitary tumors had detectable plasma bFGF-like immunoreactivity. Plasma bFGF-like immunoreactivity decreased after surgery for pituitary tumor in 4 patients and after initiation of bromocryptine therapy in 4 patients. bFGF was increased in the plasma of several subjects with sporadic endocrine disorders, including 3 with untreated or persistent acromegaly. We conclude that pituitary tumor is a possible source of high circulating bFGF immunoreactivity in MEN1 plasma.

Effects of sodium nitroprusside (MR7S1) and nitroglycerin on the systemic, renal, cerebral, and coronary circulation of dogs anesthetized with enflurane

In beagle dogs anesthetized with enflurane-nitrous oxide, effects of sodium nitroprusside (SNP; MR7S1) and nitroglycerin (NTG) on hemodynamics and main organ circulation were studied to evaluate their effectiveness and safety as hypotensive agents during anesthesia. SNP (MR7S1) infusion (1-10 micrograms/kg/min) decreased arterial blood pressure in a dose-dependent manner. The hypotension was stable during the infusion. After discontinuation of infusion, the blood pressure rapidly returned to the initial level. The hypotension was associated with decreases in cardiac output and total peripheral resistance. NTG infusion (3-10 micrograms/kg/min) decreased arterial blood pressure, too, but the hypotension was less marked and not dose dependent, and the recovery was slower. Neither drug changed the heart rate. Infusion of SNP (MR7S1) and NTG did not change the hypotension induced by the injection of adenosine, SNP, and NTG. Furthermore, cerebral blood flow, cerebral oxygen consumption, and renal blood flow were unchanged during the hypotension produced by either drug. Coronary blood flow was decreased, but this was due to decreases in cardiac oxygen consumption. In conclusion, SNP (MR7S1) is superior to NTG as a hypotensive agent during anesthesia in efficacy, clear dose dependency, and rapid recovery. The hypotension induced by NTG as well as SNP (MR7S1) seems to have no undesirable effects on the circulation of important organs.

Fading responses in the evoked EMG after rocuronium in cats

This study was performed to evaluate the inhibitory effect on motor nerve terminals by rocuronium using recovery curves of muscle compound action potentials (CAPs) and train-of-four ratios (TOFRs) in anaesthetized cats, and to compare the results with other relaxants reported previously. Recovery curves were derived from the amplitude of the CAP induced in the gastrocnemius muscle by the second of a paired stimulus (test response) to the sciatic nerve and compared with results evoked by the first component (conditioning response). The interval between the paired stimuli was increased stepwise from 7 to 1,000 msec, and the differences in amplitude of the test and conditioning responses were plotted on a graph by relating the changes in paired intervals. The recovery curve after rocuronium was less inhibited than after pancuronium, (100.4 +/- 5.9%, 82.3 +/- 6.7% and 68.5 +/- 6.7% at 60, 100 and 500 msec intervals, compared with 70.3 +/- 3.3%, 59.0 +/- 4.7% and 46.7 +/- 4.3% after pancuronium (P < 0.05). The recovery curves with d-tubocurarine were more depressed than with pancuronium; however, the RC with vecuronium was similar to that of rocuronium. The degree of fade in TOF by rocuronium was also less than those seen with d-tubocurarine and pancuronium. The results obtained suggest that rocuronium has less inhibitory effect on motor nerve terminals than do d-tubocurarine and pancuronium, and has a similar effect to that of vecuronium.

Distribution of a novel peptide in the anterior pituitary, gastric pyloric gland, and pancreatic islets of rat

We used Western blot and immunohistochemical methods to investigate the biochemical characteristics and cellular distribution of a novel peptide (peptide 23) that was previously shown to be released from anterior pituitary cells of rat in response to growth hormone-releasing hormone. In the pituitary, peptide 23 isolated from intact cells had an Mr of 31,000, whereas that released into culture medium had an Mr of 16,000. Pancreatic islets contained a 19 KD form of the peptide. Immunohistochemically, peptide 23 in the rat pituitary gland was localized in a subpopulation of somatotropes. In pancreatic islets, the peptide was found by triple immunofluorescence labeling to be present in both insulin- and somatostatin-containing cells. In the gastrointestinal tract, peptide 23 was found only in a subpopulation of endocrine cells in the pyloric glands. This subpopulation of cells was found to be entirely separate from those containing either serotonin or somatostatin, and may represent one of the other known or as yet biochemically uncharacterized cell types in this gland. The results suggest that in response to secretagogues in vitro, an altered form of the peptide is secreted from pituitary cells and that an intracellular form of peptide 23 is expressed in some but not all somatotropes, a large proportion of islet cells, and a distinct population of pyloric cells.

[Neurological sequelae caused by surgical procedures during adenoidectomy under anesthesia]

A five-year old boy with good risk was anesthetized with nitrous-oxide and halothane under orotracheal intubation for adenoidectomy and tubing of bilateral middle-ear cavities. Patient was on supine position with extension of neck. A mouth-gag was applied and the pharynx was packed with gauze. After long unskilled surgical procedures, severe neurological complications which were initiated with severe arrhythmias and followed by signs of paralysis of bilateral IX, X, XI, XII cranial nerves at their nuclei in medulla oblongata, were observed during the post-anesthetic period. The patient was saved with neurological sequelae of the cranial nerves and is alive after 6 years from the incident. The causes of this complications were discussed.

[Clinical experience of vecuronium bromide 10 mg preparation]

The neuromuscular blocking effects of vecuronium 10 mg preparation under enflurane anesthesia have been investigated in 22 patients having elective surgeries. The effect on cardiovascular system in man and laboratory examinations were also investigated. The results are as follows; 1. Onset time (time from end of injection until maximal blockade) after the dose of 0.08 or 0.1 mg.kg-1 of vecuronium bromide was about 2.6 minutes and 1.9 minutes, respectively. 2. Clinical duration of action (time from end of injection until 25% recovery of twitch) in the 0.1 mg.kg-1 group (about 50.1 minutes) was significantly longer than that in the 0.08 mg.kg-1 group (about 35.6 minutes). 3. Recovery time (time elapsing between 25 and 75% recovery of twitch) with neostigmine was 5.3 minutes (0.08 mg.kg-1) and 4.2 minutes (0.1 mg.kg-1). 4. Blood pressure was stable before and after the injection of vecuronium and no abnormal change related to the test drug was observed in the laboratory examinations. These data show that the efficacy and safety of the vecuronium 10 mg preparation are the same as those of the 4 mg preparation reported previously. In conclusion, it is considered that vecuronium 10 mg preparation is clinically useful because it is unnecessary to dissolve the drug frequently with injectable water.

Effect of carvedilol on venous return: a mechanism of reduction in blood pressure

We studied the effect of carvedilol, a beta-blocker with a potent alpha-blocking activity, on venous return in anesthetized dogs. Though 3 micrograms/kg of carvedilol caused a slight increase in blood pressure and total peripheral resistance, these changes disappeared by further doses of the agent. On the other hand, each dose of carvedilol (3-100 micrograms/kg) decreased venous return significantly and dose-dependently. These results indicate that the hypotensive effect of carvedilol mainly depends on the decrease in venous return rather than arterial vasodilation.

On the mode of cardioprotection produced by a new bradycardic agent, FR 76830, during ischaemia and after reperfusion in the isolated perfused rat heart: a 31P-NMR study

STUDY OBJECTIVE

The aim was to investigate the effects of a newly synthesised bradycardiac agent, FR 76830, on cardiac mechanical function and metabolism during ischaemia and reperfusion.

DESIGN

FR 76830 and diltiazem were infused during 15 min before ischaemia. Hearts were then subjected to ischaemia (40 min) followed by reperfusion (40 min). High energy phosphate compounds and myocardial pH were assessed by 31P-NMR. The effects of bradycardia induced by FR 76830 before induction of ischaemia on the metabolic derangement resulting from ischaemia and on functional and metabolic recovery after reperfusion were examined in comparison with diltiazem.

EXPERIMENTAL MATERIAL

Male Wistar rats (about 250 g) were used.

MEASUREMENTS AND MAIN RESULTS

FR 76830 and diltiazem produced a dose dependent decrease in heart rate before ischaemia. However, the decrease in the double product (heart rate x left ventricular pressure) was observed only with diltiazem. Both FR 76830 and diltiazem attenuated the fall in myocardial pH during early ischaemia and improved the level of ATP during late ischaemia. Diltiazem also produced an improvement in myocardial acidosis during late ischaemia and in the level of ATP during early ischaemia.

CONCLUSIONS

The importance of bradycardia in protection of the myocardial cells during early ischaemia and in preservation of ATP content during late ischaemia and after reperfusion was shown. However, to produce an improvement in myocardial pH during late ischaemia a decrease in the double product is needed.

[Ketamine infusion for control of pain in patients with advanced cancer]

The effect of ketamine infusion to control the intractable pain which had not responded to ordinary procedures in 12 patients with advanced cancer were evaluated. Ketamine 250 mg or 500 mg in 500 ml of transfusion fluid with or without 10 to 20 mg of droperidol was administered intravenously at the rate of 3 to 20mg of ketamine per hour. The pain scores by VAS in most of the patients decreased significantly with an averaged value of 8.3 before the treatment to 1 during the procedure. The durations of this therapy lasted from over 6 hours to 48 days. Slight disorientation in one patient and drowsiness in 5 were seen during the infusion. No cardiovascular or respiratory complications were noted. These results indicate that ketamine infusion is a useful therapeutic procedure to treat cancer pain which resist ordinary pain therapies.

[Study of neuromuscular transmission with evoked electromyography--10. Comparison of the responses during partial blockade by bungarotoxin and non-depolarizing relaxants]

Effects of alpha-bungarotoxin (alpha BuTX) on muscle compound action potentials (CAPs) which were elicited from gastrocnemius muscle by sciatic nerve stimulation in cats were studied, and the results were compared with those of non-depolarizing relaxants including d-tubocurarine, pancuronium and vecuronium. The amplitude of CAP by the second member of the paired stimuli (test response) was compared with that evoked by the first component (conditioning response). The interval between the two components of the paired stimuli (the pair interval) was increased stepwise from 7 to 1,000 msec and a curve (recovery curve, RC) was obtained by relating the changes in pair interval to the difference in amplitude of the test and conditioning responses. The following results were obtained. (1) A progressive and irreversible neuromuscular block was observed after intravenous administration of alpha BuTX. During the progress of the blockade, RC of CAPs showed a pattern which was characterized by profound potentiations of test responses at shorter intervals of paired stimuli, followed by gradual recovery to similar amplitude with conditioning responses at 500 msec or over of pair interval. (2) With non-depolarizing relaxants, RC changed to the pattern of slight potentiation at a very short interval of stimuli, followed by a notable depression at longer intervals. (3) The mechanism of the development of these difference of RCs between alpha BuTX and the relaxants was discussed, and it is concluded that the notable depression of RCs derived from muscle relaxants may be caused by inhibitory effect on nerve terminals of these relaxants, and the inhibition was more prominent with d-tubocurarine than with other two relaxants.

In-gel ligand blotting with 125I-heparin for detection of heparin-binding growth factors

125I-labeled heparin was used to detect basic fibroblast growth factor (bFGF) in crude tumor cell extracts after separation by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis. 125I-labeled heparin bound avidly to native recombinant bFGF immobilized on nitrocellulose and eluted with 1.5-2.0 M NaCl. However, Western transfer of bFGF to nitrocellulose after SDS-polyacrylamide gel electrophoresis destroyed heparin-binding ability. In contrast, bFGF was detected by incubation of the polyacrylamide gels directly with 125I-labeled heparin in a gel overly technique. Heparin affinity and NaCl elution pattern from bFGF in gel were similar to those observed for native bFGF spotted on nitrocellulose. This procedure permitted detection of bFGF in crude extracts of a human astrocytoma cell line. In view of the rapid growth of the heparin-binding fibroblast growth factor gene family, this technique should prove useful for the rapid and sensitive detection of other heparin-binding growth factors.

[Evaluation of the action of pipecuronium bromide in patients under halothane anesthesia--a comparison with pancuronium bromide regarding their neuromuscular blocking and cardiovascular effects]

Neuromuscular blocking and circulatory actions of pipecuronium bromide (PPB) were evaluated in patients under halothane-nitrous oxide-oxygen anesthesia in comparison with those of pancuronium bromide (PCB) in a multi-center cooperative study. Twitch tension of the adductor pollicis muscle was elicited by supramaximal stimulation of the ulnar nerve every 10 seconds. The study was performed according to the following 4 steps and the results were obtained. 1) Cumulative administration of 0.01 mg.kg-1 of PPB or PCB resulted in the potency ratio of 1.3:1.0 and the dose response curves of the two agents paralleled with each other. 2) With PPB 0.05 mg.kg-1 or 0.1 mg.kg-1, almost 100% block of the twitch was obtained. Both duration of action and the recovery time were shorter with 0.05 mg.kg-1 group. 3) After the first dose of 0.04 mg.kg-1 when the twitch recovered to 25% of the initial height 0.02 mg.kg-1 was given and this was repeated. Intervals between the doses showed large individual differences and no significant change was observed with repeated doses. 4) Safety of the drug. No significant change in heart rate or blood pressure was observed with PPB but with PCB a significant increase in heart rate was observed. The study revealed that PPB is slightly more potent than PCB and the duration of action is longer, but it has no untoward cardiovascular action in man under halothane anesthesia.

Circulating fibroblast growth factor-like substance in familial multiple endocrine neoplasia type 1

Basic fibroblast growth factor (bFGF) is a potent endothelial cell mitogen found in a variety of normal and tumor tissues. Basic FGF lacks a classical signal sequence, and it is not clear how it is released from cells. bFGF or bFGF-like activity has not been previously demonstrated in plasma. In an earlier study we showed increased mitogenic activity for parathyroid-derived epithelial and mesenchymal cells in plasma of subjects with familial multiple endocrine neoplasia type 1 (FMEN1). In the present study we examined the growth-promoting activity of normal and FMEN1 plasmas [applied to heparin-Sepharose (HS) columns] in parathyroid-derived cloned endothelial cells. FMEN1 plasma HS-adsorbed activity exceeded normal plasma HS-adsorbed activity in 6 of 8 FMEN1 plasma samples. Peak (FMEN1 plasma) HS-adsorbed activity eluted with 0.1-0.3 M NaCl, was completely neutralized by specific antibodies against bFGF, and had an apparent mol wt of 110 kD. Active fractions from FMEN1 plasma prepared by gel filtration in 7 M urea displayed apparent mol wt of about 14-16 kD and showed increased apparent affinity for HS; recovered activity appeared principally in the 3.0-M NaCl eluate. Using a sensitive two-site immunoradiometric assay for bFGF we found 0.4 ng/mL bFGF-like immunoreactivity in the highly purified 3.0-M NaCl eluate from a HS column to which the active components from gel filtration of FMEN1 plasma in 7 M urea were applied. These results imply that bFGF or closely related factors circulate in FMEN1.

Serum insulin-like growth factor I (somatomedin-C) level in normal subjects from infancy to adulthood, pituitary dwarfs and normal variant short children

Serum levels of IGF-I were radioimmunoassayed after acid ethanol extraction in 1075 normal subjects from infants through young adults, and the normal range for each age was established. The mean value for infants which was relatively low increased gradually with age, and rose sharply after that reaching the peak levels at mid adolescence, then it decreased slowly to the young adult levels. Significantly higher mean values were observed in females at the age of 9, 10, 11 and 12 years. Each of 23 cases with pituitary dwarfism exhibited a lower concentration than the lower limit of the bone age matched normal range. All of the 59 normal variant short children except three showed normal values, but the values were distributed over the lower side of the range.