Correlation of Tc-99m GSA hepatic studies with biopsies in patients with chronic active hepatitis

To determine whether scintigraphic findings of Tc-99m DTPA-galactosyl-HSA (GSA) correspond to histopathologic findings, Tc-99m GSA hepatic scintigraphy and biopsy were compared in 65 patients with chronic active hepatitis. After injecting 185 MBq of Tc-99m GSA, anterior images were obtained at 5 minutes and 15 minutes. Scintigrams were classified into three grades according to the extent of visualization of the cardiac blood pool on 5 minute and 15 minute images. Biopsies were subjectively graded for findings of necrosis and fibrosis. Scintigraphic grades on 5 minute images were correlated with hepatic necrosis and fibrosis and those on 15-minute images with hepatic fibrosis. Scintigraphic abnormalities of Tc-99m GSA correlated well with histopathologic abnormalities, especially with hepatic fibrosis and necrosis in patients with chronic active hepatitis.

Treatment of hepatocellular carcinoma: value of percutaneous microwave coagulation

OBJECTIVE

Percutaneous microwave coagulation therapy (PMCT) is a new therapeutic technique for the treatment of solid neoplasms that uses an energy source different from those of other interstitial therapies. We report our initial experience using PMCT to treat hepatocellular carcinomas.

MATERIALS AND METHODS

NIne hepatocellular carcinomas exceeding 3 cm in diameter in nine patients were treated with PMCT. Within 2 weeks before PMCT, all patients had been treated with transcatheter arterial embolization therapy, which had failed to produce complete necrosis of the tumors. PMCT was done under local anesthesia. A 14-gauge guiding needle was inserted percutaneously toward the lesion under sonographic guidance, and a needle electrode was positioned precisely within the lesion. Microwaves of 2450 MHz in frequency were produced for 60 sec with a 60-W emission. Three to 12 microwave emissions were administered in each case.

RESULTS

Dynamic CT showed that unenhanced areas indicative of coagulation necrosis developed in all lesions. All lesions appeared smaller without enhancement: on CT, the tumor diameters (mean +/- SD) were 48 +/- 13 mm before treatment and 41 +/- 13 mm 1 month after treatment. Follow-up studies showed that five lesions were controlled without any signs of recurrence. All patients tolerated the treatments well, and no serious complications occurred.

CONCLUSION

Our preliminary experience suggests that PMCT may be a useful alternative to other forms of interstitial therapy for the treatment of hepatocellular carcinomas.

Extraction of water-soluble vitamins from pharmaceutical preparations using AOT (sodium di-2-ethylhexyl sulfosuccinate)/pentane reversed micelles

Reversed micelles can be used to concentrate water-soluble materials in the water pool. In this study, the extraction of water-soluble vitamins into reversed micelles was attempted, and a flow system was used to determine the time-course of the vitamin extraction. The efficiency of extraction was strongly affected by the extraction temperature and the concentration of reversed micelles, and the selectivity depended on the size of micelles. Water-soluble vitamins could be efficiently and rapidly extracted. The selective extraction of a model mixture of vitamins from pharmaceutical preparations was also attempted. Moreover, the usefulness of the proposed method for the determination of vitamins in various commercial tablets was also demonstrated. Using of this method, the surfactant remains mixed with the extracted compounds, and so we attempted to remove the surfactant from the extract by supercritical fluid extraction. Supercritical carbon dioxide containing 7.5% ethanol as entrainer was found to be the most efficient solvent for removing residual surfactant from the extract.

Relationship between the phasic period of interdigestive migrating contraction and the systemic bioavailability of acetaminophen in dogs

The relationships of the phasic period of interdigestive migrating contraction to gastrointestinal (GI) transit of drugs and their oral absorption were investigated in mongrel dogs by simultaneous oral dosing of acetaminophen (AAP) and salicylazosulfapyridine (SASP) at the starting points of the phase I and phase III periods of gastric contractions. Strain-gauge force transducers were surgically sutured onto the serosa of the GI tracts in the dogs to measure the interdigestive migrating contractions. The mean absorption time of AAP and the time for the first appearance of sulfapyridine (a bacterial metabolite of SASP in the colon) in plasma were used as the indices of gastric emptying time (GET) and small intestinal transit time (SITT), respectively. In individual dogs, the GET and the SITT at phase I showed a clear delay in comparison with those at phase III. For AAP used as a marker compound here, the systemic bioavailability after oral dosing to intact beagle dogs at doses of 3, 10, and 20 mg/kg was about 55, 63, and 79%, suggesting that AAP undergoes a non-linear hepatic clearance. At a dose of AAP 20 mg/kg, the systemic bioavailability of AAP was 100% in the case of dosing at phase III, but was reduced by half when dosing at phase I. These results indicate that, in oral dosing, the transit of drugs through the GI tract was clearly affected by the phases of gastric contractions.(ABSTRACT TRUNCATED AT 250 WORDS)

Transcatheter hepatic subsegmental arterial chemoembolization therapy using iodized oil for small hepatocellular carcinomas. Correlation between lipiodol accumulation pattern and local recurrence

Lipiodol accumulation patterns were correlated with local recurrences after subsegmental or conventional arterial chemoembolization therapy using iodized oil (Lipiodol-TAE). Thirty-six patients with solitary small hepatocellular carcinomas (HCCs) less than 3 cm in diameter were included in this retrospective study. Superselective subsegmental catheterization was performed in 14 patients (subsegmental Lipiodol-TAE). In the remaining 22 cases, embolization was performed from the proximal portion of the hepatic artery (conventional Lipiodol-TAE). Patterns of Lipiodol accumulations within the tumors were classified in 2 groups: complete and incomplete accumulation. Complete accumulation was observed in 71% of subsegmental Lipiodol-TAE and in 32% of conventional Lipiodol-TAE. The rate of local recurrences within 12 months was significantly higher (p < 0.01) in incomplete accumulation (100%) than in complete accumulation (13%). We suggest that when small HCCs are to be treated with TAE, subsegmental Lipiodol-TAE should be performed because of its superior capability for achieving complete Lipiodol accumulation.

SecF stabilizes SecD and SecY, components of the protein translocation machinery of the Escherichia coli cytoplasmic membrane

The effect of the overproduction of SecF encoded by the tac-secF gene on a plasmid on the synthesis of other Sec proteins was studied in Escherichia coli. SecF overproduction resulted in the simultaneous overproduction of SecD encoded by the tac-secD gene on a plasmid. Deletion of the orf6 gene, located downstream of the secF gene, had no effect on SecD overproduction. A pulse-chase experiment revealed that the overproduction was due to stabilization of SecD with SecF. SecF overproduction also resulted in the overproduction of SecY encoded by the tac-secY gene on a plasmid as well. SecF overproduction also enhanced the level of SecY expressed by the chromosomal secY gene. This SecF effect was not due to its effect on SecD or SecE, since SecF overproduction did not affect the levels of SecD and SecE expressed by the chromosomal secD and secE genes, respectively. SecE-dependent overproduction of SecY has already been demonstrated. It is suggested that SecF interacts with both SecD and SecY. SecE-SecY interaction has been demonstrated. It is likely, therefore, that all Sec proteins in the cytoplasmic membrane interact with each other.

Utility of gastrointestinal physiology regulated-dogs: bioavailability study of a commercial sustained-release dosage form of theophylline

The utility of gastrointestinal physiology regulated-dogs (regulated-dogs) was evaluated in a bioavailability study. The gastrointestinal physiology of beagle dogs was regulated with a combined-treatment of intramuscular pentagastrin and intravenous atropine sulfate. Theophylline has been regarded as a drug that is absorbed completely in the entire gastrointestinal tract but slowly in the colon for humans. A commercial sustained-release tablet (SR tablet) of theophylline and a commercial conventional tablet of aminophylline (theophylline hemiethilenediamine salt) were chosen as model preparations in this study. In the regulated-dogs, the drug absorption was almost complete for the conventional tablet. The bioavailability of the SR tablet accounted for 76% in the regulated-dogs and 71% in intact dogs relative to that of the conventional tablet in the regulated-dogs, respectively, but no significant difference was detectable between these values. An advantage of the regulated-dogs over the intact dogs was, however, revealed in the time-profiles of the cumulative percentage of theophylline absorbed from the SR tablet, suggesting a modification of drug absorption by the prolonged arrival of the tablet to the colon.

[Clinical experiences of granulocyte colony stimulating factor for granulocytopenia after AC bypass]

We have successfully treated 3 cases of granulocytopenia, using Granulocyte Colony Stimulating Factor (G-CSF) after AC bypass surgery. All cases were male, aged 68, 75 & 54 years old, and underwent AC bypass surgery without transfusion except in case 1. Granulocyte cell counts decreased to 135/mm3 on 39th post-operative days (POD) in case 1, 624/mm3 on 13 rd POD in case 2, and 514/mm3 on 20th POD in case 3. In case 1, 300 micrograms of G-CSF was given intravenously for 3 days. In case 2, 100 micrograms of G-CSF for 1 day and 50 micrograms for 3 days was given subcutaneously, and in case 3, 100 micrograms of G-CSF was also given subcutaneously for 2 days. And their granulocyte cell counts all increased within few days. G-CSF is effective for patients with granulocytopenia after AC bypass surgery, but we need more experiences to know the best way of administration.

Gastrointestinal physiology-regulated dogs: utilization of a bioavailability study of a new thieno[3,2-f][1,2,4]triazolo[4,3-a][1,4]-diazepine, an antagonist of platelet-activating factor, and its preparations

The gastrointestinal (GI) physiology of beagle dogs was effectively regulated with a combined treatment using intramuscular pentagastrin (10 micrograms/kg x 2) and intravenous atropine sulfate (0.02 mg/kg x 1). The superiority of the GI physiology regulated-dogs over the intact dogs was confirmed by comparative bioavailability studies using two classes of preparations of poorly water-soluble 4-(2-chlorophenyl)-2-[2-(4-isobutylphenyl)ethyl]-6,9-dimethyl-6H- thieno[3,2-f][1,2,4]triazolo[4,3-a][1,4]diazepine (Y-24180). Both the fine granules and the tablets of Y-24180 exhibited similar absorption profiles in the intact dogs, whereas the latter preparations revealed a delayed plasma curve of the drug in the regulated-dogs. The absorption profiles of the two classes of Y-24180 preparations in the regulated-dogs simulated those in healthy volunteers. The combined-treatment of beagle dogs with pentagastrin and atropine sulfate was suggested to supply a useful animal model for predicting the absorption characteristics of poorly water-soluble drugs and their preparations in humans.

Induction and the possible mechanism of ventricular tachycardia after catheter ablation with direct current shocks in dogs

Cathodal DC shocks (150-J) were administered via the His bundle to 20 closed-chest dogs, and in a further three dogs 25-J cathodal shocks were given via the left ventricular endocardium. In 18 dogs, including three that underwent left ventricular ablation, Holter electrocardiograms were recorded from 1 to 7 days after ablation, and 4 weeks after ablation. There were frequent episodes of sustained ventricular tachycardia (VT) from the first few hours after ablation to 4 days after ablation in all dogs, but both the rate and the coupling interval of VT were variable. In five conscious dogs stimulated 1 day after ablation, it was difficult to induce and terminate VT repeatedly. There was a direct relationship between the paced cycle length and the interval of the last paced beat to the initiating VT beat in three out of four dogs. In the fourth dog there was an inverse relationship. There was no transient entrainment with ventricular burst pacing during VT in any of the four dogs tested. The effects of lidocaine (2-3 mg.kg-1), verapamil (0.2-0.4 mg.kg-1), and propranolol (0.2 mg.kg-1) on VT were tested within 2 days of ablation in 10 conscious dogs. In general, both lidocaine and verapamil terminated VT, and propranolol slowed VT. In conclusion, VT soon after ablation possibly results from triggered activity, although abnormal automaticity cannot be ruled out.

Bioavailability study of commercial sustained-release preparations of diclofenac sodium in gastrointestinal physiology regulated-dogs

The gastrointestinal (GI) physiology of beagle dogs was regulated with a combined-treatment of intramuscular pentagastrin (10 micrograms/kg x 2) and intravenous atropine sulfate (0.02 mg/kg x 1). Here, the gastric acidity, the gastric emptying time and the small intestinal transit time in the regulated-dogs were respectively around pH 2, 0.7h and 4h, approximating those in healthy humans. The superiority of the regulated-dogs over the intact dogs was confirmed in comparative bioavailability studies by using two classes of commercial preparations. Both the conventional tablet and the sustained-release capsule of diclofenac sodium exhibited simple and similar average plasma concentration-time curves of free diclofenac in the intact dogs, while the latter preparation is reported to reveal a bimodal plasma curve of the drug in healthy humans. The regulated-dogs, however, permitted a bimodal average plasma pattern of the drug for the capsules due to an approximation of the GI physiology between humans and these classes of the dogs. The combined-treatment of beagle dogs with pentagastrin and atropine sulfate seems to supply a useful animal model in predicting the absorption characteristics of the sustained-release preparations and poor water-soluble drugs.

[Percutaneous injection of cisplatin lipiodol suspension (CLS) in rabbit lung, aiming at intratumoral injection therapy for lung cancer]

Cisplatin lipiodol suspension (CLS: cisplatin 20 mg/ml) was percutaneously injected (cisplatin dose, 2, 4 or 6 mg/kg) in normal lungs of 10 rabbits (1.9-2.3 kg) to assess the safety and feasibility of intratumoral injection of CLS for lung cancer. Histological study revealed acute and chronic infiltrates with bronchiolitis and immature fibrosis at the injected lung tissue even at four weeks after injection. Intrathoracic leaks of CLS produced mild and focal fibrinous pleuritis. Intrabronchial leaks of CLS produced peripheral bronchiolitis with regenerative epithelia. However, no noxious parenchymal damage in the lung and surrounding tissues was noted. Neither oil embolism in brain nor renal toxicity was demonstrated. Seven of eight rabbits showed an increase in body weight. Concentration levels of plasma platinum were lower when compared with intravenous injection of cisplatin in the rabbit: highest at 30 minutes and unmeasurable one week after injection. Lipiodol accumulation in mediastinal lymph nodes was demonstrated in two of nine rabbits by X-ray examination, suggesting intralymphatic drainage of CLS. Intratumoral injection of CLS is safe even with CLS leaks in surrounding normal lung tissues and may be a potent therapy for controlling mediastinal lymph nodes metastasized from lung cancer as well as the primary tumor.

[Anticancer effect and side effect of arterial chemoembolization using cis-diamine-dichloroplatinum (II)/4-0-tetrahydropyranyl-adriamycin-lipiodol (CTL) suspension on hepatocellular carcinoma]

Seventeen patients with hepatocellular carcinoma were treated by intraarterial injection of CTL suspension. The doses of CTL suspension, CDDP and THP(mean +/- SD)/injection were 4.1 +/- 1.6 ml, 81.9 +/- 31.6 mg and 13.5 +/- 5.2 mg, respectively. The therapy was given once in 10 patients, twice in 6 and 4 times in one. Over 50 per cent reduction in tumor size was obtained in 5 patients (30%). Fifty or more % decrease in serum alpha-feto-protein (AFP) levels was observed in 3 of 7 patients (43%) with the initial serum AFP level of more than 200 ng/ml, Fever, abdominal pain, nausea and vomiting were noted in most cases. However, they disappeared within 2 weeks after therapy was completed. No severe complications were encountered except one case of a liver abscess which healed by administration of antibiotics. No severe changes in laboratory data were observed. This study suggests that a new method of intraarterial injection must be developed to enhance the therapeutic effect even more, in addition to an increased injection dose of CDDP/THP-LPD and higher concentration of CDDP and THP in LPD.

Overproduction, purification and characterization of SecD and SecF, integral membrane components of the protein translocation machinery of Escherichia coli

SecD and SecF proteins were overproduced by means of recombinant DNA technology. Immunoblot and amino-acid sequencing analysis revealed that the overproduced proteins are SecD and SecF. The SecD- or SecF-overproduced membrane fraction was subjected to differential solubilization. The SecD protein was then purified through ion-exchange and size-exclusion chromatographies. The SecF protein was purified through size exclusion chromatography. Proteoliposomes reconstituted from the purified SecD and SecF together with SecE and SecY were used to analyze the translocation activity. SecD and SecF did not exhibit significant effects on the translocation activity of proteoliposomes. The amounts of SecD and SecF in overproducers were determined densitometrically on a stained SDS gel and their overproduction (fold) was determined by means of immunoblot analysis. Then the number of these molecules in one normal cell were estimated. From these numbers, together with those of other Sec proteins, the number of the translocation machinery existing in one Escherichia coli cell was inferred to be around 500.

Idiopathic necrosis of the femoral epiphyseal nucleus in rats

To study the cause of osteonecrosis of the femoral head in spontaneously hypertensive rats, the site and mechanism of the occlusion of the blood vessels feeding the femoral head were investigated histologically and microangiographically. Tracing the blood vessels using serial sections revealed that the lateral epiphyseal vessels disappeared immediately before entry into the ossific nucleus. As the reparative process advanced, the blood vessels from the lateral side of the head entered the ossific nucleus again. To investigate the relationship between osteonecrosis and mechanical stress on the femoral head, some treatments to reduce mechanical stress were applied, and the frequency of the femoral head lesions, such as osteonecrosis, disturbed ossification, and abnormality of the growth plate, was compared among the groups of treatments for stress relief. The incidence of femoral head lesions was found to be directly proportional to the mechanical stress working on the area, as was evident from a decrease in the incidence of osteonecrosis as a result of reduction of mechanical stress. Thus, the obstruction of the vessels in the lateral part of the femoral head might result from the breakdown of cartilage caused by the mechanical stress on the femoral head.

A case of a pseudomalfunction of a DDD pacemaker

DDD pacemaker pseudomalfunction occurred in a 65-year-old man. This was due to premature ventricular contraction (PVC) response option and cross-talk detection window, which are designed to protect against pacemaker related tachycardia or cross-talk. Pseudomalfunction disappeared by eliminating PVC response option.

Gastric mucosal hexosamine content in various liver diseases

Since gastric mucosal lesions are frequently encountered in patients with liver disease, we measured the levels of gastric mucosal hexosamine. In chronic hepatitis patients, hexosamine levels were reduced in both the antrum and corpus as compared with those in normal controls, while values in the advanced liver cirrhosis group (total bilirubin greater than 5 mg/dl) were lower than in the less advanced group. Although the presence or absence of esophageal varices had no influence on hexosamine, higher concentrations were found in patients with the red color sign (+) in comparison with those with negative red color sign (-). One month after endoscopic injection sclerotherapy of esophageal varices, hexosamine did not change, but decreases were seen in both the antrum and corpus at 3 months. We observed an increase in gastric mucosal blood flow after treatment with teprenone, a new antiulcerative agent, in normal controls. Gastric mucosal hexosamine increased significantly after teprenone treatment in both chronic hepatitis and liver cirrhosis groups. From these results, we conclude that hexosamine has a defensive action against gastric lesions in various liver diseases.

[Avascular necrosis in the femoral head of spontaneously hypertensive rats--correlation between microangiographic and histological findings]

The site of interrupted blood flow in the necrotic femoral heads of growing spontaneously hypertensive rats (SHR) and the state of the circulation during the reparative process were investigated by microangiography. The microangiographic findings of the femoral epiphysis were classified into the following four types: 1) uniform distribution of radiopacity; 2) absence of radiopacity in the medial portion; 3) complete absence of radiopacity; and 4) intercourse of blood vessels between the epiphysis and the metaphysis. These four types corresponded closely to the degree of the reparative process after necrosis and the retardation of ossification. The absence of blood vessels indicated the absence of reparative reaction or non-occurrence of ossification. These findings suggest that necrosis of the femoral head in SHR occurs as a result of interrupted blood flow outside the epiphyseal nucleus.

Removal of famotidine by haemodialysis in elderly anuric patients

The effect of haemodialysis on the pharmacokinetics of oral famotidine has been studied in five elderly anuric patients. Famotidine 20 mg was administered in a cross-over design to patients on and not on haemodialysis. The elimination rate constant of haemodialysis (k) was 4.6-fold larger than the systemic elimination rate constant (ke). Although the mean maximum serum concentration of famotidine during haemodialysis (141.5 ng.ml-1) was not significantly lower than that without haemodialysis (195.6 ng.ml-1), the AUC up to 5 h during haemodialysis was significantly decreased to 58.1% of the value without it. The data suggest that famotidine is dialysable by haemodialysis.