Analyses of bronchoalveolar lavage fluid (BALF) in MRL-lpr/lpr mice

We performed bronchoalveolar lavage (BAL) in MRL-lpr/lpr (MRL/l) and MRL- +/+ (MRL/n) mice and evaluated various cellular and humoral components of the bronchoalveolar lavage fluid (BALF) to clarify the pathogenic mechanism of pulmonary fibrosis in MRL/l mouse. The numbers of macrophages, neutrophils and lymphocytes, N-Acetyl-beta-glucosaminidase (beta-NAG), and fibronectin increased in the BALF from MRL/l mice than that from MRL/n mice, but no significant differences were observed in total protein, beta-glucuronidase, acid phosphatase, or phospholipid level. Increased fibronectin level in the BALF from MRL/l mice may be related with pathogenesis of pulmonary fibrosis.

[Effect of continuous epidural infusion of morphine on postoperative glucose metabolism]

Plasma growth hormone (GH), insulin, prolactin and blood glucose levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in 16 patients who underwent gastrectomy. Continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia) was given to eight (epidural morphine group) patients. A bolus of epidural morphine was administered through an indwelling thoracic (Th8.9) catheter at 3 hrs prior to the expected end of surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042 mg.hr-1 with the pump during and after anesthesia and surgery with gradually decreasing dose until the third postoperative day. The remaining eight patients (systemic analgesics group) repeatedly received intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma GH levels increased significantly only on the first postoperative day in both groups. Plasma insulin levels increased significantly on the first postoperative day in both groups. Blood glucose levels increased significantly at the end of surgery and during the following three postoperative days in both groups. There are no statistical differences in plasma GH, insulin and blood glucose levels between the two groups. Plasma prolactin concentrations increased significantly at the end of surgery and they were significantly higher in the systemic analgesic group than in the epidural morphine group. They, however, returned to the previous day's levels on the first postoperative day in both groups. Our study suggests that continuous epidural infusion of morphine has no suppressing effect on postoperative changes in plasma GH, insulin, prolactin and blood glucose levels as compared with systemic analgesic regimen.

[Hypothermia after cardiopulmonary bypass in man: effects of prostaglandin E1 and phentolamine]

The "afterdrop" in body temperature (TEMP) following adequate rewarming from hypothermic cardiopulmonary bypass (CPB) is frequently observed. This temperature drop sometimes accompanied by shivering results in increased myocardial oxygen demand. We investigated the relations between the afterdrop and use of vasodilators after CPB. For vasodilator therapy, PGE1 at the rate of 0.025-0.088 microgram.kg-1.min-1 (Prostaglandin Low Doses, PLD; n = 8), 0.107-0.136 microgram.kg-1.min-1 (Prostaglandin High Doses, PHD; n = 7), or phentolamine at 4.1-5.9 micrograms.kg-1.min-1 (PHENT; n = 8) were intravenously infused in 23 adult patients after CPB. During three hour period after CPB, esophageal, rectal, and forehead TEMP are lower in PHENT than in PGE1 groups. There were significant differences between PHD and PHENT group. Finger tip TEMP was lower in PGE1 groups than in PHENT group. There were significant differences between PHD and PHENT group. There were no differences in systemic arterial pressure, cardiac index (CI) and systemic vascular resistance (SVR) at any point between PHD and PHENT groups. It is concluded that PHENT increases the peripheral skin blood flow and TEMP but decreases the visceral TEMP possibly due to vasodilatation of the skin vessels, while PGE1 decreases skin blood flow and TEMP but increases the visceral TEMP, although SVR clearly decreases at the same rate in the two groups.

[Three cases of alveolar soft part sarcoma and MRI findings]

Three cases of alveolar soft part sarcoma were reported with characteristic MRI findings. On MRI findings, slightly higher signal intensity than muscles on T1 weighted image and remarkably high signal intensity on T2 weighted image were thought to be characteristic of alveolar soft part sarcoma.

Decreased glucose utilization during prolonged anaesthesia and surgery

We studied the influence of prolonged anaesthesia and surgery on glucose metabolism by means of the euglycaemic insulin clamp method in eight patients who underwent prolonged surgery. Eleven patients who underwent surgery of short duration served as a control group. Plasma concentrations of catabolic hormones were measured simultaneously. Glucose utilization during prolonged anaesthesia, (PA) group, was lower than that in the control group (P less than 0.01) (glucose utilization 7.59 +/- 0.73 mg.kg-1.hr-1 in the control group vs 4.03 +/- 0.71 mg.kg-1.hr-1 in PA group respectively). There were no significant differences in plasma catecholamine and glucagon concentrations between the PA and control groups. Plasma-free fatty acid levels increased significantly in the PA group before the euglycaemic insulin clamp (free fatty acid level: 0.496 +/- 0.053 mmol.L-1 in the control group, vs 0.834 +/- 0.103 mmol.L-1 in the PA group at the pre-clamp period, P less than 0.01). Tissue resistance to exogenous insulin increased during prolonged anaesthesia and surgery although there were no significant changes in plasma catabolic hormone levels.

The effects of augmented hemodynamic forces on the progression and topography of atherosclerotic plaques

In order to clarify mechanisms determining different degrees of vulnerability of atherogenesis between the apical and the proximal lateral walls at branchings, both regions of the inferior mesenteric artery in human autopsy cases were investigated electron microscopically. The lateral wall and the apex have been accepted by many researchers as the most preferential and the most resistant sites, respectively, for the disease. In regard to blood flow, the apex is exposed to laminar high shear stress, but the outer lateral wall to turbulent low shear stress. In newborns, intimal thickness in the apex was greater than that in the lateral wall, due mainly to the proliferation of SMC. After the 3rd decade, collagen fibers drastically increased in the apical intima, and SMC embedded between the collagen fibers, modulating their phenotypes from synthetic to contractile. In the lateral intima, SMC remained as the synthetic type. Synthetic SMC are considered capable of proliferation in the arterial wall. The lateral intima was generally abundant in proteoglycans and lacked collagen (including subendothelial basement membranes) as well as elastic fibers, particularly in the upper part of the intima. Such a structural difference may cause favorable conditions for atherosclerosis. Results of in vitro studies revealed that collagen gel suppressed proliferation of SMC and changed their phenotype from synthetic to contractile. Therefore, laminar high shear stress gives the arterial wall resistancy to atherogenesis through this phenotypic change. Rabbits showed preferential regions in certain areas of the flow divider for lipid deposition which were different from those of human beings. These regions were covered by ellipsoidal endothelial cells, which should be exposed to relatively low mean shear stress. Ellipsoidal endothelial cells had already been observed in intact rabbits. Therefore, we can conclude that atherogenic processes could be initiated by relatively low mean shear stress in either humans or rabbits.

[Endocrine and hemodynamic responses to total body hyperthermia in humans]

We investigated effects of total body hyperthermia (TBH) on endocrine and hemodynamic responses. A total of five treatments were performed in five patients with gastric cancer under neuroleptanesthesia with morphine followed by 0.2 to 0.4% enflurane. TBH was extracorporeally induced with veno-venous shunt incorporating with heat exchanger to keep their temperature between 41.5 degrees C and 42.0 degrees C for three hours. The patients were administered angiotensin to maintain tumor blood flow. Lactated Ringer's solution was administered at the rate of 10 to 15 ml.kg-1.hr-1 for five hours. Plasma cortisol levels decreased significantly to about one third of the control value after heating and the levels recovered to the control value after cooling. Plasma norepinephrine level increased significantly to about 7 to 9 times the control value following TBH, but this hormonal response was insufficient to reveal marked direct hemodynamic effects. The magnitude of fall in SVR was more significant in spite of the administration of angiotensin. Cardiac index increased significantly to about 2.0 to 2.6 fold of control value, but mean arterial blood pressure (MAP) decreased significantly to about two thirds to four fifths of the control value. Morphine relieved the hormonal response in ACTH and cortisol strongly, but morphine suppressed hemodynamics by decreasing SVR. Neither norepinephrine released from sympathetic nerve endings nor even 50 to 200 ng.kg-1.min-1 of angiotensin administered failed to restore SVR or MAP during hyperthermia.

[Plasma catecholamine levels following continuous epidural infusion of morphine for postoperative analgesia in surgical patients]

Plasma catecholamine levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in sixteen patients who underwent gastrectomy. Eight patients (epidural morphine group) obtained postoperative analgesia with continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia). A bolus of morphine was administered through an indwelling thoracic (Th8 X 9) epidural catheter 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042mg.hr-1 by the pump during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) received repeatedly intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma epinephrine levels increased significantly at the end of surgery in both groups, and were higher in the systemic analgesics group than those in the epidural morphine group. In the epidural morphine group, the catecholamine levels decreased to the previous day's levels on the first postoperative day and afterward, but remained high during three postoperative days in the systemic analgesics group. Plasma norepinephrine levels increased significantly at the end of surgery and afterward in both groups. However, they were significantly higher in the systemic analgesics group than in the epidural morphine group. Plasma dopamine levels were unchanged in the epidural morphine group during the surgical procedures, but they increased significantly on the first postoperative day and thereafter in the systemic analgesics group. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and exerts a suppressing effect on plasma catecholamine levels as compared with systemic analgesics regimen.

Spontaneous regression of esophageal carcinoma with pulmonary metastases: case report

The first description of a spontaneous regression of a primary esophageal carcinoma with progressive growth of multiple pulmonary metastases is reported, and the possible cause of the spontaneous regression is discussed briefly with reference to T cell subsets. A 78-year-old Japanese man underwent an esophageal bypass with gastric substitution for carcinoma of the middle to lower third of the intrathoracic esophagus with aortic invasion. Two months after the operation, multiple pulmonary metastases were documented and were seen to progress gradually over the next six months. Seven months later, all the secondary lesions underwent a complete spontaneous regression. The primary lesion also regressed, but did not disappear completely. It was not possible to establish whether a change in T cell subsets was the cause or an effect of the regression.

Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: special emphasis on ductal obstruction and genesis of pancreatitis

We compared alcoholic pancreatitis (AP), which is thought to be caused by protein plugs, and chronic obstructive pancreatitis (COP), distal to carcinoma, both histopathologically and immunohistochemically. Eighteen cases of AP showed marked and irregularly distributed interlobular fibrosis. The exocrine parenchyma and its immunoreactivity against anti-amylase were rather well preserved, except in the advanced stages of the disease. Protein plugs and pancreatic stones were found. Fifteen cases of COP showed a uniform distribution of inter- and intralobular fibrosis, marked destruction of the exocrine parenchyma, and loss of amylase concentration. Neither protein plugs nor pancreatic stones were found. Anti-collagen immunoreactivity was found in both types of pancreatitis. Although obstruction of the main or small pancreatic ducts is considered to be the principal factor in the genesis of both AP and COP, the histological features of the two diseases are quite distinct from one another. Therefore, duct obstruction caused by protein plugs appears not to be the main factor in the genesis of alcoholic pancreatitis.

[Reaction products of sevoflurane with components of sodalime under various conditions]

Sevoflurane is reported to react with sodalime to resolve into several products. We examined the reaction products of sevoflurane when this anesthetic reacted with components of sodalime under various conditions. Analysis of reaction products was performed by gas chromatography using a 2m column packed with DOP. Six peaks including sevoflurane were detected on the gas chromatogram of sevoflurane after reaction with sodalime and five reaction products were obtained. These peaks were from P1 with the shortest retention time to P5 with the longest retention time. When sevoflurane was sealed with sodalime in a test tube at room temperature, only P1 was detected and all reaction products of P1 to P5 were identified when the test tube was heated at 50 degree C for 3 hours. Sodalime contains Ca (OH)2, NaOH, KOH and silicon dioxide. Reaction of sevoflurane with KOH produced P1 to P5 products even at room temperature. After the reaction of sevoflurane with NaOH or Ca (OH)2 at 50 degrees C, P1 to P5 or P1 only were detected on the chromatogram respectively. No peak of any reaction products was obtained after the reaction with silicon dioxide under various conditions. These results suggest that hydroxy group of sodalime component would increase reaction products of sevoflurane.

[Effects of sevoflurane anesthesia and surgery on plasma catecholamine levels]

Effects of sevoflurane-nitrous oxide-oxygen anesthesia and surgery on plasma levels of epinephrine, norepinephrine and dopamine were evaluated in twenty four patients who ranged in ages from 15 to 65 years. They underwent non-abdominal surgery (orthopedic surgery) or abdominal surgery (gastrointestinal or gynecological surgery). Anesthesia was induced and maintained with sevoflurane in 50% nitrous oxide and 50% oxygen. Succinylcholine was administered intravenously to facilitate tracheal intubation and pancuronium was given intravenously during surgery. Lactated Ringer's solution at a speed of 5-15 ml.kg-1.h-1 was also administered intravenously throughout the procedures. Neither plasma epinephrine, norepinephrine nor dopamine levels changed significantly during the anesthetic induction with sevoflurane anesthesia. Plasma catecholamines were unchanged during and after surgery in patients who underwent non-abdominal surgery, while plasma epinephrine and norepinephrine levels increased significantly during and after abdominal surgery. Plasma dopamine levels, however, were unchanged during and after surgery in these patients. The findings suggest that epinephrine and norepinephrine secretion was significantly stimulated with abdominal intervention but not with orthopedic one under sevoflurane anesthesia.

[Effect of dexamethasone and ACTH on plasma atrial natriuretic polypeptide levels during hemorrhage in rats]

Anti-shock effect of dexamethasone (Dexa) and ACTH on atrial natriuretic polypeptide (ir-ANP) secretion was studied during hemorrhage in rats as reflected in the plasma ir-ANP, corticosterone (Comp B) and ACTH levels. We also observed the number of survived rats and plasma ir-ANP levels stimulated by volume loading of the shed blood or fluid. The rats were divided into non-treated group (saline), Dexa group (Dexa 5mg.kg-1) and ACTH group (ACTH 200 micrograms.kg-1). They were anesthetized by intravenous injection of pentobarbital sodium 30 mg.kg-1. Atrial blood sample for control value was collected before hemorrhage. Approximately 20% and then 30% of the estimated blood volume was taken for hemorrhage. Hemorrhage induced significant reductions in plasma ir-ANP levels. They decreased from a control value of 133.8 +/- 6.1 pg.ml-1 to 76.6 +/- 4.2 pg.ml-1 (P less than 0.005), but plasma levels of Comp B and ACTH increased markedly. The ir-ANP secretion increased in response to the elevation of atrial pressures after volume loading. The administration of Dexa and ACTH to the rats tended to inhibit the reduction of plasma ir-ANP levels during hemorrhage and improved the survival rate 24hr after bleeding 30% of the estimated blood volume.

Plasma levels of endotoxin and anaphylatoxin in patients with multiple organ failure

Plasma concentrations of endotoxin and anaphylatoxins were studied inpatients with multiple organ failure (MOF). Thirty one blood samples from nine patients with MOF and twenty samples from preoperative patients as control were determined. The average plasma concentration of endotoxin was 188.7 +/- 37.0 pg-ml-1 (Mean + S.E.) in MOF patients and 12.4 +/- 3.3 pg.ml-1 in control patients (p less than 0.05). Plasma anaphylatoxin (C3a, C5a) levels increased significantly and C4 level decreased in MOF patients as compared with those in control patients. However, no significant correlation was found between plasma endotoxin and anaphylatoxin levels. Endotoxin does not seem to be a major factor in activating of the complement system in patients with MOF.

[Plasma morphine levels during its continuous epidural infusion]

We evaluated plasma levels of morphine during its continuous epidural infusion for postoperative analgesia in nine adult patients. A bolus injection of 3 mg of morphine was administered epidurally 3 hours prior to the proposed end of the surgery, and thereafter continuous epidural infusion of morphine was continued at a rate of 0.167-0.042 mg.hr-1 with a pump (CADD-PCA, 5200P, Pharmacia) during and after the surgery until the 3rd postoperative day. The dose of morphine was gradually decreased to 0.021-0.042 mg.hr-1 without reducing the quality of postoperative analgesia. Plasma morphine levels were measured by gas chromatography-mass spectrometry method. Plasma concentrations of morphine were 4.6 +/- 0.7 (Mean +/- SE) ng.ml-1 at the end of surgery and they decreased thereafter to 0.7 +/- 0.1 ng.ml-1, 0.3 +/- 0.1 ng.ml-1 and 0.1 +/- 0.1 ng.ml-1 on the 1st, 2nd and 3rd postoperative days, respectively. Plasma levels of morphine decreased gradually correlating with reduction of infused morphine. Adequate postoperative pain relief was obtained throughout the procedure without any severe complications such as respiratory depression. The analgesic effect of epidural morphine did not parallel with that of plasma concentration. Plasma concentrations of morphine administered by continuous epidural infusion with a pump were estimated to be lower than the minimum analgesic plasma concentration (10-40 ng.ml-1), and the toxic levels of morphine during continuous epidural infusion were not detected by our method.

[An anesthetic experience of a patient with congestive cardiomyopathy]

A 54 year-old man with congestive cardiomyopathy underwent total cystectomy with formation of ileal conduit under fentanyl anesthesia. Preoperative status was evaluated to be very risky with ASA 3, Goldman cardiac risk index 28 and NYHA 3. Cardiac function was evaluated with Swan-Ganz catheter during anesthesia with fentanyl (30 mcg.kg-1) and 60% nitrous oxide. Dopamine, dobutamine and vasodilators (prostaglandin E1, trinitroglycerin) were continuously infused intravenously to decrease high afterload and enhance diminished cardiac contractility. On the 7th post-operative day, massive atelectasis in the right lung was observed, which was improved by positive pressure ventilation and vigorous bronchial lavage. A careful management with meticulous anesthetic care is emphasized for patients with congestive cardiomyopathy.

The effect of pentobarbital and ether anesthesia on rat brain PGD2 content

Effects of pentobarbital and ether anesthesia on PGD2 contents in brain and plasma levels of compound beta, A.C.TH. epinephrine (E) norepinephrine (NE) and dopamine were investigated in 39 male Wistar strain rats weighing 280-300 g. They were divided into 3 groups: pentobarbital anesthesia group (P.A.), ether anesthesia group (E.A.) and control. Anesthesia or not the rats were decapitated the heads were frozen with liquid nitrogen and PGD2 were extracted and assayed by radioimmunoassay. In the group of P.A. and E.A., PGD2 contents of the brain were decreased by 69.6% and 77.8% of the control group respectively. In the group PA, plasma levels of Comp-beta, ACTH, E and NE were significantly decreased. In the EA group, plasma levels of Comp-beta was not changed but that of ACTH, E and NE were significantly increased. In the EA and PA groups, plasma levels of dopamine were not significantly changed. Intraventricularly injected PGD2 has been reported to induce the natural sleep in rat, increase or decrease the pain threshold and lower the body temperature in rat. On the other hand, intravenous injection of PGD2 has been reported to prolong the duration of pentobarbital anesthesia in rat or changed the EEG pattern to slow wave in cat. Stresses including restrain and foot shock have been reported to increase the PGE2 and PGF2a in the brain of rat. The present findings demonstrate that pentobarbital and ether anesthesia decreased the PGD2 contents in the brain of rat.

[Effects of intravenous anesthetics and analgesics on plasma alpha-rat atrial natriuretic peptide (alpha-rANP) levels in rats]

Effects of various intravenous anesthetics and analgesics on alpha-rat atrial natriuretic peptide (alpha-rANP) concentrations in the plasma were studied in unrestrained rats. Morphine (30 mg.kg-1), fentanyl (0.2mg.kg-1) and buprenorphine (1mg.kg-1) produced 10-, 10- and 3.3-fold significant increases in plasma alpha-rANP over control group at 20min after intraperitoneal injections of each drug, respectively. A marked increase in plasma alpha-rANP after morphine administration was still observed at 60min, but those after fentanyl and buprenorphine were reduced to 4.7-from 10.0-fold and 1.6-from 3.3-fold increase at 60min, respectively. Pentazocine (40mg.kg-1) significantly increased plasma alpha-rANP to 1.3 times higher than that of control group only at 60 min, while ketamine (40mg.kg-1) caused an insignificant increase in plasma alpha-rANP to 1.4 and 1.3 times at 40 and 60 min. Droperidol (10mg.kg-1) tended to decrease plasma alpha-rANP and a significant reduction was observed at 60 min. Propofol (40mg.kg-1) did not affect on plasma alpha-rANP. Pentobarbital (50mg.kg-1) produced an insignificant fall in plasma alpha-rANP. Plasma levels of ACTH, compB and aldosterone increased after injections of morphine and fentanyl. These results indicate that mu-type opiate receptor plays an important role in secreting alpha-rANP and activating pituitary-adrenal axis in the rats.

Detection of a circulating tumor-associated antigen with a murine monoclonal antibody, LISA 101, selected by reversed indirect enzyme-linked immunosorbent assay

In the presence of a characterized monoclonal antibody recognizing a soluble molecule, additional monoclonal antibodies reactive with unknown antigenic determinants on the molecule can be easily selected by reversed indirect enzyme-linked immunosorbent assay. A novel murine monoclonal antibody, LISA 101, was selected by reversed indirect enzyme-linked immunosorbent assay against soluble antigens, which exist in sera and in pleural effusions derived from lung adenocarcinoma patients and which bear determinants recognized by the previously characterized murine monoclonal antibody KL-6. Antigenic determinants recognized by the LISA 101 antibody appear to be sialylated carbohydrate in nature and different from those recognized by previously reported monoclonal antibodies against sialylated carbohydrates, such as NS 19-9, FH-6, and KL-6, suggested by competitive inhibition assay and immunostaining of tissues. A circulating antigen, LISA 1-6, was detected by a bimonoclonal bideterminant assay using immobilized LISA 101 antibody and enzyme-labeled KL-6 antibody. It was found that serum LISA 1-6 levels were elevated in 63% (25 of 40) of patients with lung adenocarcinoma and in 92% (11 of 12) of patients with pancreatic carcinoma, but only in 6.5% (2 of 31) of patients with benign lung diseases and in 7.1% (1 of 14) of patients with pancreatitis. The present observations indicate that the LISA 1-6 antigen may serve as a new tumor marker for adenocarcinomas of the lung and the pancreas. Additionally, the reversed indirect enzyme-linked immunosorbent assay may be a widely applicable method for selecting new monoclonal antibodies against as yet unknown antigenic determinants on soluble molecules.