[Effect of continuous epidural infusion of morphine for postoperative analgesia on pituitary-adrenocortical function]

Plasma levels of cortisol, ACTH and beta-endorphin like immunoreactivity (beta-ELI) were measured to evaluate postoperative pain relief with epidural morphine and systemic analgesics in conjunction with endocrine functions in 16 patients who underwent gastrectomy. Eight of these patients (epidural morphine group) obtained postoperative analgesia with continuous epidural infusion of morphine with a pump as in our previous report. A bolus of epidural morphine was administered through an indwelling thoracic (Th8,9) catheter at 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042 mg.hr-1 with a pump (CADD-PCA, Model 5200P, Pharmacia) during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) repeatedly received systemic pentazocine and buprenorphine when needed. Plasma cortisol levels increased significantly at the end of surgery and after in both groups. However plasma concentrations of cortisol in the epidural morphine group were significantly lower than those in the systemic analgesics group on the first and second postoperative days. Plasma levels of ACTH and beta-ELI increased significantly at the end of surgery but returned to levels of the previous day in both groups postoperatively. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and has suppressing effect on plasma cortisol levels as compared with systemic analgesics regimen.

[Effects of modified NLA with droperidol and eptazocine and surgery on pituitary-adrenocortical function in man]

Effects of modified NLA with droperidol + eptazocine on pituitary-adrenocortical function were evaluated in ten patients who received abdominal hysterectomy. They were premedicated adequately. The induction of anesthesia was started with eptazocine 30 mg iv and thiopental 3-4 mg.kg-1 iv and the trachea was intubated smoothly following succinylcholine 40 mg iv. Then, they were given intravenous droperidol 0.15 mg.kg-1 with inhalation of 70% N2O and 30% O2. Good intraoperative muscle relaxation was obtained by dialferine or pancuronium. Five ml of the venous blood was taken on six occasions as follows; before the anesthetic induction, 5 and 30 minutes after the induction, 30 and 60 minutes after the start of surgery and finally at full recovery from anesthesia in the recovery room. The blood samples were immediately centrifuged and the plasma was separated and stored at -20 degrees C until measurement. Plasma cortisol, ACTH, human growth hormone (HGH) and prolactin (PRL) were measured for evaluation of the anterior pituitary-adrenocortical function. No significant increase in plasma levels of cortisol, ACTH and HGH were observed during anesthesia alone, but they increased significantly during surgery. Plasma levels of PRL increased significantly soon after the induction. These results were similar to those of other neuroleptic anesthesia. The systemic blood pressure and the heart rate were stable during anesthesia and surgery, and plasma eptazocine concentration determined by GC-MS showed that effective concentrations of eptazocine were maintained during surgery. These data suggest that modified NLA with droperidol and eptazocine would deserve a further detailed clinical study.

[Prolonged respiratory depression following general anesthesia in a patient with dystrophia myotonica]

A case of general anesthesia for a 52 year old female with previously undiagnosed dystrophia myotonica was reported. The patient was diagnosed as flaccid paralysis of the bilateral lower extremities but myotonic symptoms were not found preoperatively. The patient underwent duodenal resection to have a benign tumor removed. Anesthesia was induced with thiamylal 250 mg and pancuronium bromide 4 mg intravenously to facilitate tracheal intubation. Anesthesia was maintained with enflurane (0.6-1.0%) in nitrous oxide (50%) and oxygen (50%). The course of anesthesia was uneventful except for a transient hypotension of 80 mmHg systolic for about 10 minutes. The patient did not recover smoothly from anesthesia and prolonged apnea was observed. 90 minutes after the end of surgical procedure, spontaneous ventilation appeared. Then the tidal volume increased gradually but it still remained around 100-150 ml even 3 hours after the end of the operation. She was on ventilator and observed carefully. The endotracheal tube was removed four days after the operation. The patient was examined again by a neurologist and a final diagnosis of dystrophia myotonica was made. Prolonged recovery from anesthesia and postoperative respiratory depression observed in this patient was due to preoperatively undiagnosed dystrophia myotonica. A careful preoperative examination should be made to minimize possible complication related to anesthesia in the disease.

Cardiac distribution of alpha-hANP in an infant with total anomalous pulmonary venous return

Atrial natriuretic polypeptide like immunoreactivity (irANP) was searched in the right and left atrial and ventricles following necropsy of a 2-month-old boy who underwent anesthesia for radical surgery to total anomalous pulmonary venous return (TAPVR), who could not be removed from a cardiopulmonary bypass. The irANP concentration was 630 micrograms.g-1 in the right atrium, 3.2 micrograms.g-1 in the right ventricule in 1 100 micrograms.g-1 in the left atrium and 1.7 micrograms.g-1 in the left ventricle, respectively in spite of numerous studies reported that ir ANP cannot be detected in adult ventricles.

Exacerbation of toxic effects by endotoxin contamination of recombinant human tumor necrosis factor

The toxic effects of endotoxin-free human recombinant tumor necrosis factor (rH-TNF), shown to contain less than 50 pg endotoxin/mg rH-TNF, were investigated and compared with those of rH-TNF and endotoxin coadministered at 4-400 ng endotoxin/mg rH-TNF in female Sprague-Dawley rats. The mean lethal dose of 5.9 mg/kg rH-TNF found for the endotoxin-free rH-TNF was far higher than that attributed to rH-TNF by other investigators. Coadministration with endotoxin derived from E. Coli. Salmonella abortus equi, or Serratia marcescens reduced the apparent mean lethal dose of rH-TNF in correspondence to the endotoxin concentration, with a value of 0.7 mg/kg rH-TNF observed at 1600 ng, 757 ng, and 5260 ng endotoxin/mg rH-TNF, respectively. Coadministration also resulted in more severe histopathologic and physicochemical effects than rH-TNF alone. Histopathologic abnormalities observed only in coadministration included interlobular edema and hemorrhage of the pancreas and, most remarkably, splenomegaly, which was not observed with rH-TNF alone even at lethal doses. The results indicate that particular care in determining endotoxin contamination is essential in any consideration of TNF toxicity.

[An anesthetic experience with a patient with ornithine transcarbamylase deficiency]

We report an anesthetic experience with ornithine transcarbamylase deficiency. The patient was 26 years of age who underwent open biopsy of the liver for a definitive diagnosis. OTC deficiency is an X-linked disorder of urea cycle. One of the anesthetic problems is how to control the blood ammonia level resulting in neurological damage which occurs following anesthesia and surgery. Recently it has been advocated that benzoate is effective to prevent hyperammonemia in patients with OTC deficiency. As patients with this disease are frequently complicated with hepatic dysfunction, anesthetics which may cause hepatic damage such as halothane should be avoided.

A histopathological, immunohistochemical and ultrastructural study of intranuclear cytoplasmic inclusions in thyroid papillary carcinoma

Intranuclear cytoplasmic inclusions (ICI) in 38 cases of thyroid papillary carcinoma were studied histopathologically, immunohistochemically, and ultrastructurally in order to examine the frequency of ICI and their relationship to both the histological structure and cytological findings in thyroid papillary carcinoma. The fine-structure and biochemical state of ICI were also studied. ICI occurred in all 38 cases. ICI occurrence ranged from one in several microscopic fields to more than ten per field. The number of ICI divided by the number of nuclei on the microscopic photographs ranged from 0.013 to 0.116. The frequency of ICI was strongly influenced by the state of nuclear chromatin and pleomorphism, but was not influenced by a pattern of papillary or follicular tumour growth. Immunohistochemically, 10-30% of ICI revealed strong thyroglobulin (Tg), which was ascertained by immunoelectron microscopy. Neither T3 nor T4 was detected in ICI (with some exceptions). Some ICI showed keratin and vimentin. PAS-positive ICI were observed. Ultrastructurally, enlarged r-ER, many Golgi vesicles and small vesicles (diameter of 300-500 nm) and sacs were observed in ICI. These findings suggested increased protein synthesis and/or protein accumulation. Abundant secondary lysosomes, showing degradation of ICI, and bundles of condensed intermediate filaments were also detected. The character and genesis of ICI are discussed.

Somatic mutation in peripheral lymphocytes of former workers at the Okunojima poison gas factory

The former workers at the Okunojima poison gas factory comprise a high risk group for malignant tumors such as respiratory tract cancer. Demonstration of injury to somatic cell genes in this group may provide important data for evaluating the association between mustard gas and malignant tumors. So we measured the frequency of T lymphocytes lacking the hypoxanthine guanine phosphoribosyl transferase (HGPRT) activity, by cloning with interleukin 2 (IL2). In this study, we performed cloning of T lymphocytes lacking the HGPRT activity using recombinant IL2 (rIL2) and observed an increased frequency of somatic mutation in poison gas workers who had had more chances to be exposed to mustard gas and those who had worked for a longer period. This result suggested that inhalation of small amounts of mustard gas damaged somatic cell genes, resulting in carcinogenesis.

[A clinico-pathological study regarding the incidence of intranuclear cytoplasmic inclusions (ICI) in cases of papillary thyroid carcinoma]

Intranuclear cytoplasmic inclusions (ICI) in 38 cases of thyroid papillary carcinomas have been studied as to the relationship between the frequency of ICI and the clinical, histological, and cytological findings of the carcinoma. ICI were present in all cases. The frequency of ICI in the cases studied ranged from +/- (one per several fields) to ¿ (more than ten per one field), using a microscope of 400 magnifications, and from 1.3% to 11.6% (mean value: 3.9%) of the nuclei of the carcinomas. The frequency of ICI was found to be influenced by the state of the nuclear chromatin and pleomorphism, but was not influenced by the papillary or follicular tumor growth. The relationship between the frequency of ICI and the tumor size and the existence of lymph-nodes metastasis, however, was not clarified.

Are illusory contours a cause or a consequence of apparent differences in brightness and depth in the Kanizsa square?

The causal flows between the processes responsible for illusory contour clarity, brightness, and apparent depth in the Kanizsa square were examined. The sixty-four stimuli used consisted of all possible combinations of eight disk luminances and eight centre-to-centre separations between nearest disks. Ten subjects were instructed to rate the clarity of the illusory contour and the brightness and apparent depth differences between the Kanizsa square and its surround in each stimulus. On the basis of results obtained with the causal inference method, using partial correlations and path analysis, it is suggested that clarity of illusory contour can be influenced directly by disk separation, and that the output from the process responsible for illusory contour clarity has some effect on the processes responsible for the apparent depth and brightness differences.