[Let's study pharmacokinetics related to anesthesiology by using computer graphics: intravenous drugs]

The pharmacokinetics of intravenous drugs used during anesthesia provides us important information for patients' care. The pharmacokinetic data are usually shown in a graphic expression together with numerical values. The numerical values are only convenient for investigators in exchanging their knowledge and information. The graphic data contain, however, whole and real information obtained in a pharmacokinetic study. The authors demonstrated a way to derive information from graphic data, which is practically applicable for patients' care. We also showed a way to calculate numerical values from graphic data by using "graphnote" by Fukutake Pub. Co. We believe that our manual way to calculate numerical values from graphic data, with an aid of computer graphics combined with scientific calculator, helps us to understand the invisible processes performed inside "a black box" or a computer installed with a commercially available soft ware for the pharmacokinetics.

Establishment of a human cell line (HCC-T) from a patient with hepatoma bearing no evidence of hepatitis B or A virus infection

A human hepatoma cell line, designated HCC-T, was established. The tumor was surgically obtained from a Japanese male patient with hepatocellular carcinoma (HCC) arising in a cirrhotic liver that had supposedly developed from nonAnonB (NANB) chronic hepatitis. HCC-T exhibited a typical morphology of epithelial cells in culture. Population doubling time was 24 hours and HCC-T cells had characteristics of malignant cells demonstrated by the ability to grow in a soft agar medium and transplantability to nude mice. The histologic condition of the tumor transplanted to a nude mouse showed similarity to the original tumor. A chromosome analysis showed that there were ten identifiable marker chromosomes and sex chromosomes with its modal number of 64. Alpha-fetoprotein (AFP) production was demonstrated by direct immunofluorescence study, but albumin or hepatitis B surface antigen were not detectable. The integration of hepatitis B viral DNA was not demonstrable in the genome of HCC-T cells or the original hepatoma.

Establishment of a human cell line (HCC-T) from a patient with hepatoma bearing no evidence of hepatitis B or A virus infection

A human hepatoma cell line, designated HCC-T, was established. The tumor was surgically obtained from a Japanese male patient with hepatocellular carcinoma (HCC) arising in a cirrhotic liver that had supposedly developed from nonAnonB (NANB) chronic hepatitis. HCC-T exhibited a typical morphology of epithelial cells in culture. Population doubling time was 24 hours and HCC-T cells had characteristics of malignant cells demonstrated by the ability to grow in a soft agar medium and transplantability to nude mice. The histologic condition of the tumor transplanted to a nude mouse showed similarity to the original tumor. A chromosome analysis showed that there were ten identifiable marker chromosomes and sex chromosomes with its modal number of 64. Alpha-fetoprotein (AFP) production was demonstrated by direct immunofluorescence study, but albumin or hepatitis B surface antigen were not detectable. The integration of hepatitis B viral DNA was not demonstrable in the genome of HCC-T cells or the original hepatoma.

Establishment of a human cell line (HCC-T) from a patient with hepatoma bearing no evidence of hepatitis B or A virus infection

A human hepatoma cell line, designated HCC-T, was established. The tumor was surgically obtained from a Japanese male patient with hepatocellular carcinoma (HCC) arising in a cirrhotic liver that had supposedly developed from nonAnonB (NANB) chronic hepatitis. HCC-T exhibited a typical morphology of epithelial cells in culture. Population doubling time was 24 hours and HCC-T cells had characteristics of malignant cells demonstrated by the ability to grow in a soft agar medium and transplantability to nude mice. The histologic condition of the tumor transplanted to a nude mouse showed similarity to the original tumor. A chromosome analysis showed that there were ten identifiable marker chromosomes and sex chromosomes with its modal number of 64. Alpha-fetoprotein (AFP) production was demonstrated by direct immunofluorescence study, but albumin or hepatitis B surface antigen were not detectable. The integration of hepatitis B viral DNA was not demonstrable in the genome of HCC-T cells or the original hepatoma.

In vivo visualization of oxyradical-dependent photoemission during endothelium-granulocyte interaction in microvascular beds treated with platelet-activating factor

Oxyradical-dependent chemiluminescence from granulocytes sticking to venular endothelium was successfully visualized in rat mesenteric microvascular beds treated with platelet-activating factor (PAF). Intravital photonic image intensifier microscopy revealed that topical application of PAF-acether (100 nM) caused remarkable granulocyte adherence on endothelial walls and the subsequent activation of a luminol-dependent photonic burst. Chemilumigenic sites clearly corresponded to the spatial distribution of sticking cells in post-capillary venules. The present findings thus serve as the first demonstration of an intravital oxidative burst of granulocytes on venular endothelium in PAF-induced microcirculatory disturbances.

Cefotiam disposition in markedly obese athlete patients, Japanese sumo wrestlers

Markedly obese athletes like Japanese sumo wrestlers may frequently suffer various traumas which result in the prophylaxis or treatment of posttraumatic infection with antibiotics. However, appropriate dosage regimens in this group of patients have not been fully known for many antibiotics. Therefore, we studied the kinetic disposition of cefotiam, a parenteral, broad-spectrum cephalosporin with activity against gram-positive and -negative bacteria, after an intravenous dose (2 g) infused over 30 min into 15 sumo wrestler patients with an excess body weight (130 to 220% of ideal body weight) and 10 control patients with a normal weight (90 to 102% of ideal body weight). Mean (+/- standard deviation) clearance and steady-state volume of distribution were significantly greater in the sumo wrestler than in the control group (38.3 +/- 9.4 versus 23.5 +/- 6.0 liters/h, P less than 0.001, and 30.2 +/- 8.0 versus 17.9 +/- 6.1 liters, P less than 0.001). Mean elimination half-life was slightly but significantly longer in the sumo wrestler than in the control group (0.91 +/- 0.14 versus 0.74 +/- 0.20 h, P less than 0.05). However, mean residence time did not differ between the two groups (0.79 +/- 0.10 versus 0.75 +/- 0.14 h). The statistical differences in clearance and volume of distribution between the two groups disappeared when these kinetic parameters were corrected for body surface area, but not for total body weight or ideal body weight. The results suggest that the dosage calculation of cefotiam, a hydrophilic antibiotic, should be made on the basis of body surface area in morbidly obese athlete or sumo wrestler patients. However, whether this recommendation should extend to other nonathlete obese subjects remains to be determined.

Effects of serine protease inhibitors on oxyradical burst from phagocytizing neutrophils--analysis by chemiluminescence counting and its microscopic imaging

Reaction difference of oxyradical generation and luminol-dependent photoemission of zymosan- and phorbol ester-treated neutrophils were investigated using a conventional photomultiplier and ultrasensitive photonic imaging technique. Zymosan-treated cells released a concentrated photonic burst corresponding to the cellular distribution. In contrast, phorbol ester-treated cells produced a negligible level of photoemission, and the additional application of Ca2+ ionophore enhanced the photonic burst, which was gradually spread out into extracellular space. Serine protease inhibitors did not attenuate PMA-induced chemiluminescence but did attenuate zymosan-induced chemiluminescence. This suggests the involvement of serine protease in the respiratory burst of phagocytizing neutrophils.

Heat generation as an index of exhaustion of soda lime

The wall temperatures of the absorptive chambers of a divided soda lime canister were measured in 70 patients to determine the relationship between the difference in temperature of the two chambers and CO2 passage through the first chamber. CO2 passage through the first chamber was detected when the temperature of the second chamber became equal to that of the first. A significant correlation (R = 0.94; P less than 0.001) was found between the magnitude of CO2 passage through the first chamber and the difference in temperature between the chambers. When the maximal absorptive capacity of soda lime was reached, the pH of the surface of soda lime granules was still too high to change the indicator color. Exhaustion of soda lime is more reliably recognized by measuring wall temperatures of the chambers than by observing color change of the soda lime granules.

Endotoxin-induced hypercoagulability: a possible aggravating factor of alcoholic liver disease

The present experiments were designed to study the effect of chronic ethanol consumption on endotoxin toxicity. The intravenous injection of endotoxin produced a more pronounced increase of serum AST and ALT activities in chronic ethanol-fed rats, when compared to controls. The activities of hepatic mitochondrial enzymes, succinate dehydrogenase and cytochrome oxidase, were also distinctly decreased by endotoxin treatment in chronic ethanol-fed rats. Consistent with these biochemical alterations, light and electron microscopic examinations revealed severe liver injury after endotoxin injection in chronic ethanol-fed rats. Furthermore, the increase of blood BUN and creatinine levels accompanied by the degeneration of the renal tubulus and slight infiltration of neutrophils into the glomerule were produced by endotoxin treatment and were more conspicuous in chronic ethanol-fed rats than controls. Therefore, the biochemical and histological evidence indicates that endotoxin markedly potentiates organ injury after chronic ethanol consumption. In addition, a more pronounced decrease in blood antithrombin III activity accompanied by an increase in fibrin degradation product level in blood was recognized in chronic ethanol-fed rats receiving endotoxin, when compared to controls receiving endotoxin. This increase of blood fibrin degradation product level correlated well with the decrease of antithrombin III activity (r = -0.6116; p less than 0.005). These findings of blood antithrombin III activity and fibrin degradation product level indicate that the coagulation-fibrinolysis system is more activated by endotoxin treatment after chronic ethanol consumption. Furthermore, the activation of the coagulation-fibrinolysis system was well correlated with biochemical and histological alterations representing hepatorenal involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of Go alpha mRNA and protein in bovine tissues

Go alpha is a 39-kDa guanine nucleotide-binding protein (G protein) similar in structure and function to Gs alpha and Gi alpha of the adenylate cyclase complex and to transducin (Gt alpha) of the retinal photon receptor system. Although expression of Go alpha protein has been reported to be tissue-specific, other workers have found Go alpha mRNA in all rat tissues examined. In order to clarify this contradiction, studies to verify the distribution of Go alpha mRNA and protein in bovine and rat tissues were performed. Tissues were screened for the presence of Go alpha mRNA by use of a series of restriction fragments of a bovine retinal cDNA clone, lambda GO9, and oligonucleotide probes complementary to sequences specific among G alpha subunits for the 5' untranslated and coding regions of Go alpha. These probes hybridized predominantly with mRNA of 4.0 and 3.0 kb in bovine brain and retina. A 2.0-kb mRNA in retina also hybridized strongly with the cDNA but weakly with the oligonucleotide probes. In bovine lung, two mRNAs of 1.6 and 1.8 kb hybridized with the cDNA while only the 1.6-kb species hybridized with the coding-region oligonucleotide. In bovine heart, only a 4.0-kb mRNA was detected and in amounts much less than those in the other tissues. A similar distribution of Go alpha mRNAs was seen in rat tissues. In bovine tissues, Go alpha protein was identified with rabbit polyclonal antibodies directed against purified bovine brain Go alpha. An immunoreactive 39-kDa membrane protein was found principally in retina and brain, and in a lesser amount in heart.(ABSTRACT TRUNCATED AT 250 WORDS)

[An experimental study on the severe type of alcoholic liver disease--a pathogenetic role of potentiated activation of complement system by endotoxin after chronic ethanol consumption]

Endotoxemia frequently appears in severe type of alcoholic liver disease. However, we have little knowledge how endotoxin influences the progression of alcoholic liver injury. Thus, to study the causal mechanism for the progression to the severe type of alcoholic liver diseases, endotoxin (0.2 mg/100 g BW, E. Coli O26:B6) was intravenously injected in chronic ethanol-fed rats and controls, and then, rats were sacrificed after 16 hours of endotoxin treatment. The elevation of serum GOT and GPT activities induced by endotoxin was significantly higher in chronic ethanol-fed rats than controls, and these biochemical changes were well correlated with the grade of necrosis of liver histology. Furthermore, in chronic ethanol-fed rats, endotoxin treatment tremendously increased blood BUN and creatinine levels and produced the degeneration of renal tubuli with neutrophil infiltration into glomerulus. These experimental findings are very similar to the severe type of alcoholic liver disease. On the other hand, endotoxin significantly decreased serum values of CH50 in chronic ethanol-fed rats, but not in controls. Such alterations of CH50 induced by endotoxin were well correlated with the several parameters indicating the injury of liver and kidney. Therefore, the present study may indicate that chronic ethanol ingestion aggravates endotoxin-induced organ injury, and that the activation of complement system may associate with such progression of organ injury.

[Effect of combined administration of HBs antigen and anti-HBs antibody on induction of anti-HBs antibody production in vitro and in vivo]

It was considered that nonresponsiveness to hepatitis B surface antigen was in part due to a failure in the antigen recognition (i.e., antigens' phagocytosis, processing and presentation by accessory cells). In order to enhance the capture of antigens, we investigated the effect of simultaneous administration of HBs antigen and anti-HBs IgG on antibody responses in vitro and in vivo. As a result, in vitro sensitization of mononuclear cells from anti-HBs-positive subjects with HBs antigen and anti-HBs IgG induced significant amounts of anti-HBs IgG production in 5 of 6 cases, whereas sensitization with HBs antigen alone failed to induce the antibody production in most cases. In vivo administration of HBs vaccine and anti-HBs immunoglobulin to non-responders to the vaccine triggered active anti-HBs antibody responses in 3 of 7 cases in vivo and in 5 of 7 cases in vitro.

Prediction of prognosis of patients with idiopathic dilated cardiomyopathy: a comparison of echocardiography with cardiac catheterization

The prognostic values of indices obtained by M-mode and two-dimensional echocardiography (Echo) and by cardiac catheterization (Cathe) were assessed in patients with idiopathic dilated cardiomyopathy. Fifty-one patients with this disorder (38 males and 13 females) were studied for an average of 4.2 years. Of those, 24 died of cardiac causes during follow-up. The overall 5-year survival rate was 49%. Significant differences between the surviving patients and the patients who died were noted in the following indices measured by Cathe: left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic pressure (LVEDP), ejection fraction (EF), and the cardiac index (CI). The 5-year survival rate in patients with the following index values measured by Cathe at the initial examination were: LVEDV greater than or equal to 150 ml/M2 - 29%; LVEDP greater than 12 mmHg - 35%, EF less than 30% - 21%, and CI less than 3.0 L/min/M2 - 29%. In contrast, the 5-year survival rate in patients with the following parameter values measured by Echo were: left ventricular end-diastolic dimension greater than or equal to 45 mm/M2 - 16%; left atrial dimension greater than or equal to 25 mm/M2 - 12%; ejection fraction less than 30% - 31%; and a relative wall thickness (a ratio of left ventricular posterior wall thickness to left ventricular end-diastolic dimension) less than or equal to 0.12 - 9%. In assessing the cumulative survival rate, the indices provided by Echo revealed similar values when compared with those obtained by Cathe. The relative wall thickness determined by Echo would be the most reliable parameter for forecasting the 5-year survival rate.(ABSTRACT TRUNCATED AT 250 WORDS)

DNA-dependent mono(ADP-ribosyl)ation of p33, an acceptor protein in hen liver nuclei

A non-histone acceptor protein for hen liver nuclear ADP-ribosyltransferase was purified to an apparently homogeneous state through salt extraction and chromatography on hydroxyapatite, phenyl-Sepharose, carboxy-methyl-cellulose, Sephadex G-75, phenyl 5-PW, mono S and Radial PAK C18. This protein was termed p33. The ADP-ribosylation of p33 was enhanced more than 60-fold by double-stranded DNA. Single-stranded DNA, RNA and poly(L-glutamate), but not deoxyribonucleotide, were partially effective. DNA-dependent ADP-ribosylation was also observed when whole histones were used as acceptor. DNA required for the maximal ADP-ribosylation depended on the dose of the acceptor protein; the optimal mass ratio of DNA to the acceptor protein was 1:1 with both p33 and whole histones. DNA decreased the Km for NAD and concomitantly increased the Vmax value, but did not alter the Km for p33. These results are consistent with the idea that p33 may participate in chromatin processes such as replication or transcription, through modification by nuclear ADP-ribosyltransferase.

[Radiation therapy of choroidal metastases]

A retrospective study was performed on 30 cases with choroidal metastases referred to the Cancer Institute Hospital between July 1975 and June 1986. Of these 30 cases, 32 eyes of 26 patients were treated with irradiation of 4.3 MV X-rays or 12 MeV electron beam therapy in the range of 20-60 Gy to restore vision and prevent blindness. The tumor response to radiation therapy confirmed by ophthalmoscopic examination was described as complete, partial or no response. Of the 32 eyes, 31% had complete response, and 47% showed partial response. The overall response rate was 78%. A visual response as defined by marked or partial improvement of visual acuity and/or subjective symptoms was obtained in 16 out of 26 patients (62%). All of these patients were free of recurrence of symptoms in their quality of life. This proved radiotherapy to be a useful modality of treatment for choroidal metastases. No obvious radiation injuries were encountered in this series.

Fluorescent histochemical study on the localization of myofibroblasts in the healing of acetic acid-induced gastric ulcers in the rat

The changes in the localization of FITC-phalloidin-positive smooth muscle cells and interstitial cells were studied in control and acetic acid-treated rat fundic mucosae. In the control rats, the FITC-phalloidin-positive cells mostly corresponded to smooth muscle cells of the muscularis mucosae, and arteriolar and venular smooth muscle cells. On the other hand, the fluorescence of the smooth muscle cells of the muscularis mucosae disappeared and a large number of fluorescent interstitial cells appeared in the regenerated mucosal layer in rats one week after the acetic acid-treatment, while three weeks after the application, severely thickened fluorescent muscularis mucosae were formed.

[Radiation therapy in brain metastases]

From 1980 to 1985, 126 patients with a brain metastases from various malignant tumors were treated by hypervoltage irradiation with conventional fractionation at the Department of Radiotherapy at the Cancer Institute Hospital. The patients without an extracranial metastases or without neurological symptoms had a longer survival than did the other patients. Radiotherapy of more than 30 Gy improved the neurological functions and reduced the risk of death from the brain metastases. For long-term local control of brain metastases, whole brain irradiation with boost therapy for localized lesions may be a better treatment than other radiation methods and the total radiation dose required may be more than 50 Gy.

Prolylhydroxylase and collagenase activities in the healing of acetic acid-induced gastric ulcers in rats and the effects of cimetidine and elcatonin

We examined the changes in prolylhydroxylase (PH) and interstitial collagenase (CA) activities in the healing of acetic acid-induced gastric ulcers in rats. Gastric ulcers were induced by subserosal injection of acetic acid, and confirmed by endoscopy on the third day. At the acute stage of ulceration, PH activity was not high but CA activity was increased. At the healing stage, PH activity was increased but CA activity gradually decreased to a normal level. Cimetidine did not effect PH activity but tended to increase CA activity in the healing. On the contrary, elcatonin increased PH activity but had little effect on CA activity. The above enzymes seems to be indispensable in the healing of gastric ulcers and effects of antiulcer agents on these enzymes must be considered.

Halothane, an inhalation anesthetic, activates protein kinase C and superoxide generation by neutrophils

The rate of superoxide generation of guinea pig intraperitoneal neutrophils by a chemotactic peptide or 12-O-tetradecanoylphorbol-13-acetate (TPA) was increased by 2-bromo-2-chloro-1,1,1,-trifluoroethane (halothane), an inhalation anesthetic. This increase was inhibited by 1-(5-isoquinolinesulfonyl)methylpiperazine dihydrochloride (H-7), a specific inhibitor of Ca2+- and phospholipid-dependent protein kinase C (PKC). Halothane was found to significantly activate partially purified PKC. The activation required phosphatidylserine (PS) and Ca2+. Dioleoylglycerol- or TPA-activated PKC activity was further increased by halothane. The cytoplasmic proteins of guinea pig neutrophils phosphorylated by halothane-activated PKC were similar to those phosphorylated by PMA-activated PKC. The phosphorylation of a 48 kDa protein, a phosphorylated protein required for NADPH oxidase activation, was also increased by halothane. These data suggest that the increase of superoxide production by halothane is correlated with its activation of PKC.