[Successful chemotherapy in postoperative brain metastasis of breast cancer using ACNU--two case reports]

Two cases of postoperative brain metastasis of breast cancer were evaluated after chemotherapy using ACNU. Case 1: A 47-year-old female, who had undergone right standard radical mastectomy in 1979 for breast cancer (T2 N0M0, papillo-tubular carcinoma), was treated with ADM, TAM, and 60Co irradiation for bone metastasis in 1983. In 1984, she complained of loss of consciousness and paralysis of the extremities due to brain metastasis. After chemotherapy using ACNU (100 mg X 3), brain metastasis could not be detected on CT. She remained asymptomatic for more than 9 months without recurrence after therapy. Case 2: A 46-year-old-female, who had undergone left standard radical mastectomy in 1980 for breast cancer (T1 N1 M0, medullar tubular carcinoma), complained of headache and vertigo accompanying a hard tumor in the scalp. Chest X-ray and CT demonstrated right lung metastasis and left cerebellar metastasis. After combination chemotherapy using ACNU (100 mg) + MMC (4 mg) i.v. and FT (600 mg/day) p.o., symptoms and tumor on CT disappeared for 10 months after therapy. However, the patient died of aggravation of angina pectoris and D.M. from which she had been suffering for several years previously. These two cases correspond to complete response (CR) according to the response criteria proposed by Koyama-Saitoh.

[Encapsulated subdural empyema--a case report with special reference to CT findings and operative indications]

A case of encapsulated subdural empyema was reported. This 1.5-year-old boy was admitted with the increasing confusion and convulsion. Eight months prior to admission, he had craniotomy for traumatic acute epidural hematoma on the left side. Following a coagulation of the middle meningeal artery which was the bleeding source, the dura was opened but no cortical damage was noted at that time. The computed tomographic (CT) scan on admission revealed a large subdural collection with a thin enhancing rim on the left side. Emergency craniotomy revealed a collection of subdural pus, which was irrigated and a catheter was put for continuous drainage. Postoperatively, the patient did well, however, following removal of the catheter, three weeks after the first operation, the subdural empyema was reexpanded with a very thick enhancing rim on CT scan. Ultrasonography also clearly demonstrated the formation of the thick membranes. The large craniotomy was performed and empyema with the outer and inner membranes of 8 mm thick was totally excised. Postoperative CT scan did not show any enhancing rim, indicating that enhancement was caused by newly formed vessels within the membranes per se. This findings are totally different from those observed in the brain abscess in which ring enhancement on CT continues months to years following so-called extracapsular excision of abscess. In the brain abscess, surrounding glial tissue with plenty neovascularization is left intact, even after the operation.

A genetic analysis of morphine responses in mice

To investigate whether genetic factors may play a role in the difference of the responses to morphine between inbred strains of mice, we determined the effect of morphine on the plasma cyclic nucleotides, the motor activity and the rectal temperature in the 2 progenitor strains of mice, DBA and C57BL, their F1 and F2 hybrids, and the 2 backcross progenies between F1 and parental strains. C57BL was partially dominant over DBA concerning the motor activity induced by morphine, whereas DBA was partially dominant over C57BL in terms of the increase in plasma cyclic nucleotides and the hypothermia elicited by morphine. The biometric analysis suggested that the strain difference in the effects of morphine was genetically determined except for plasma cyclic AMP, and that among these quantitative traits, the effects of morphine on motor activity and rectal temperature were controlled by more than one allelic gene pairs.

[Clinical evaluation of tissue concentrations of cefotiam applied in the field of thoracic surgery]

Seven patients who were performed thoracotomy for the disease of the chest, were administered cefotiam dihydrochloride 2.0 g for about an hour by intravenous drip infusion during their operation. Antibiotic levels of serum and intrathoracic tissues (a piece of lung parenchyma, parietal pleura, pulmonary hilar lymph node, chest wall muscle, pulmonary cyst and nerve) were determined, and an evaluation of bactericidal effect was discussed. In this study, we found that antibiotic level of poor blood supplied lung, so called the destroyed lung was remarkably high. This means that a high concentration of cefotiam dihydrochloride to intrathoracic tissue is effective against postoperative infection.

Acute physical dependence induced by continuous intravenous infusion of morphine or meperidine in the rat

An intravenous infusion method is described for rapidly producing physical dependence in rats. Rats were infused with morphine or meperidine for 24 or 48 h at constant rates and the development of physical dependence was assessed by body weight loss after naloxone challenge. Naloxone challenge induced body losses that were dependent upon magnitude, rate and duration of infusion. The steady-state concentrations of morphine (4 mg/kg/h) in serum and meperidine (6 mg/kg/h) in plasma were 4 and 2.5 microgram/ml, respectively. Morphine concentration in the brain in the steady-state (40 mg/kg/h) was 0.7 micrograms 1 g and in the serum was proportional to the infusion rate. Maximum body weight loss was significantly correlated with total amount of infused morphine, but not with the steady-state concentration of the drug in the serum. These results suggest that total doses of infused morphine, not steady-state concentrations, are critical in producing body weight loss.

Suppressive effect of morphine on serum gonadotropin levels in castrated rats

A single administration of morphine reduced both serum LH and FSH levels in castrated Wistar rats. As the inhibitory effect of morphine on serum LH was antagonized by naloxone, the opiate receptors are involved. Decrease in the serum FSH levels induced by morphine was considerably less than the decrease in serum LH, and naloxone did not significantly reverse this effect of morphine on serum FSH. Increase in the serum LH induced by exogenous LHRH was slightly potentiated and not inhibited by a large dose of morphine, in both intact and castrated rats. Increase in the serum FSH in intact male rats induced by exogenous LHRH was not altered by morphine. In the castrated animals, exogenous LHRH did not further increase the serum FSH levels and the latter was not altered by a concomitant administration of morphine. These results clearly show that the decrease in serum gonadotropin levels by morphine is not due to inhibition of the stimulatory effect of LHRH on the pituitary gland. The mechanism of the differential suppression on serum LH and FSH by morphine is postulated.

Effect of morphine on the release of thyroid-stimulating hormone stimulated by exposure to cold, thyroidectomy and the administration of thyrotrophin releasing hormone in male rats

Morphine reduced the release of thyroid-stimulating hormone (TSH) which stimulated by exposure to cold and by thyroidectomy as well as reducing the basal level of TSH in the serum of male rats. Thi inhibitory effect of morphine was antagonized by naloxone which did not enhance the basal or cold-induced TSH release. Pretreatment with morphine did not reduce the release of TSH induced by exogenous thyrotrophin-releasing hormone (TRH) but enhanced it. This effect of morphine was also antagonized by naloxone. The above results suggested that the effect of morphine in reducing levels of serum TSH was not mediated by blocking the effect of TRH on the anterior pituitary gland, but that it was probably mediated by the inhibition of the release of TRH.

Effects of repeated administration of potassium canrenoate (SC-14266) on serum gonadotrophin, prolactin, testosterone and progesterone in male rats

Chronic administration of potassium canrenoate (SC-14266), a water-soluble anti-aldosterone agent, increased serum LH levels in male rats without altering serum levels of FSH, prolactin, testosterone and progesterone. The increase in serum LH may be due to the anti-androgenic effect of potassium canrenoate.

Inhibition by cholinergic agonists of the prolactin release induced by morphine

The cholinergic agonists, pilocarpine, physostigmine and nicotine, inhibited the prolactin release induced by morphine in male rats in vivo. Pilocarpine also inhibited the release of prolactin induced by beta-endorphin or metoclopramide without affecting the basal and haloperidol-stimulated serum prolactin levels. The inhibitory effect of pilocarpine on the morphine-stimulated release of prolactin was antagonized by concurrent administration of atropine but not by atropine methylnitrate or by mecamylamine, while the inhibition by nicotine was antagonized by mecanylamine but not by atropine. The stimulation of prolactin release by morphine and its reversal by pilocarpine were observed after the administration of haloperidol or alpha-methyltyrosine. These results suggest that the central cholinergic system exertes an inhibitory influence on the prolactin release induced by morphine or beta-endorphin and the cholinergic inhibition is not mediated via catecholaminergic neurons.

Effect of narcotic analgesics and naloxone on proestrous surges of LH, FSH and prolactin in rats

Morphine (50 mg/kg), given at 12:00 h and 14:00 h to proestrous rats, completely inhibited the proestrous surges of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin (Prl). However, when it was given at 16:00 h, the inhibitory effect of morphine (Mor) was decreased. Pethidine and nalorphine inhibited the proestrous surges, while pentazocine showed a weaker inhibitory effect. Naloxone (Nx), given simultaneously or 2 h after morphine (Mor), at 1/20 the dose of Mor, inhibited the blockade of the proestrous gonadotropin release exerted by Mor, while the onset of the surges was delayed when it was given 3 h after Mor.

Effects of morphine on the serum prolactin levels of morphine-tolerant and nontolerant male rats and of the in vitro release of pituitary prolactin

Morphine increased the serum prolactin (PRL) levels of male rats in a dose response manner. This effect was abolished by naloxone and apomorphine, but was not affected by diphenhydramine. The increase in the serum PRL levels by haloperidol was abolished by apomorphine, but not by naloxone. Repeated administrations of increasing doses of morphine attenuated the response of serum PRL to morphine. Naloxone did not alter the serum PRL levels of morphine-tolerant rats, while it precipitated full withdrawal signs on these rats. Although neither haloperidol nor morphine increased the release of PRL from the isolated anterior pituitary, haloperidol, but not morphine, reversed the inhibition by dopamine of the in vitro release of pituitary PRL. These results indicate that tolerance develops regarding the effect of morphine with a resulting increase in the serum PRL levels, abstinence precipitated by naloxone has no effect on the serum PRL levels, the mechanism of morphine involved in increase in the serum PRL is different from that of haloperidol as the effect of haloperidol is not antagonized by naloxone and morphine does not antagonize the effect of dopamine which inhibits the release of PRL from the anterior pituitary in vitro.

Time course of effects of morphine on hypothalamic content of LHRH and serum testosterone and LH levels of morphine-tolerant and nontolerant male rats

Time course of the effects of morphine on the hypothalamic content of LHRH in both nontolerant and morphine-tolerant male rats was investigated in relation to the temporal changes of serum testosterone and LH levels. The hypothalamic LHRH content of the nontolerant rats was increased 8 hr after the administration of morphine (100 mg/kg) when serum testosterone levels were depressed. The LHRH content of the tolerant rats was decreased during withdrawal of morphine for 48 hr when the lowered serum testosterone and LH levels had returned to within the control levels. Although the hypothalamic LHRH content does not necessarily reflect the release of LHRH, these results are in favour of the hypothesis that the release of hypothalamic LHRH is inhibited by the administration of morphine and is restored by the withdrawal of the narcotic.

Effects of morphine and naloxone on serum LH, FSH and prolactin levels and on hypothalamic content of LH-RF in proestrous rats

Proestrus surges of serum LH, FSH and prolactin (PRL) were significantly reduced when morphine HCl (50 and 10 mg/kg) was administered to 4-day cycling rats just prior to the proestrous critical period. The inhibitory effect of morphine was reversed by naloxone, a morphine antagonist, at the dose which had no effect on the proestrus surges of serum LH, FSH or PRL. The hypothalamic LH-RF content of proestrous rats at 1800 hr (during the proestrus surge) was not significantly different from that at 1400 hr (before the surge) and was not affected by pretreatment with morphine or naloxone. Our results suggest that naloxone reverses the anti-ovulatory effect of morphine by antagonizing the inhibitory effect of morphine on preovulatory surges of gonadotropins or PRL.