Long-term administration of amlodipine prevents decompensation to diastolic heart failure in hypertensive rats

OBJECTIVES; We assessed the effects of long-term amlodipine administration in a diastolic heart failure (DHF) rat model with preserved systolic function as well as the relationship between changes in left ventricular (LV) myocardial stiffening and alterations in extracellular matrix.

BACKGROUND

Although the effect of long-term administration of amlodipine has been shown to be disappointing in patients with systolic failure, the effect is unknown in those with DHF.

METHODS

Dahl salt-sensitive rats fed a high-salt diet for seven weeks were divided into three groups: eight untreated rats (DHF group), eight rats given high-dose amlodipine (10 mg/kg/day; HDA group) and seven rats given low-dose amlodipine (1 mg/kg/day; LDA group).

RESULTS

High-dose administration of amlodipine decreased systolic blood pressure and controlled excessive hypertrophy, without a decrease in the collagen content, and prevented the elevation of LV end-diastolic pressure at 19 weeks. Low-dose administration of amlodipine with subdeppressive effects did not control either hypertrophy or fibrosis; however, it prevented myocardial stiffening and, hence, the elevation of LV end-diastolic pressure. The ratio of type I to type III collagen messenger ribonucleic acid levels was significantly lower in both the HDA and LDA groups than in the DHF group.

CONCLUSIONS

Long-term administration of amlodipine prevented the transition to DHF both at the depressor and subdepressor doses. Amlodipine did not decrease the collagen content, but attenuated myocardial stiffness, with inhibition of the phenotype shift from type III to type I collagen. Thus, amlodipine may exert beneficial effects through amelioration of collagen remodeling in the treatment of DHF.

Ventricular production of natriuretic peptides and ventricular structural remodeling in hypertensive heart failure

OBJECTIVES

Brain natriuretic peptide (BNP) is a strong predictor of left ventricular (LV) hypertrophy (LVH) and dysfunction. However, our recent studies suggested that LVH is not necessarily associated with enhanced production of BNP in hypertension. This study aimed to clarify the relation of the characteristics of hypertrophy with the degree of gene expression of BNP in the developmental process of hypertensive heart failure.

METHODS

Serial changes in LV geometry, histology and atrial natriuretic peptide (ANP) and BNP mRNA levels, were assessed in a hypertensive heart failure model using Dahl salt-sensitive rats (n = 24). We further studied effects of alpha1-receptor antagonist (doxazosin: 1 mg/kg per day, n = 5) and angiotensin II type 1 receptor (AT1R) antagonist (candesartan cilexetil: 1 mg/kg per day, n = 5).

RESULTS

The BNP mRNA level was not elevated at the compensatory hypertrophic stage when ANP mRNA level was elevated. BNP mRNA level was increased with further progression of hypertrophy and development of fibrosis. AT1R blockade prevented such fibrosis and further progression of hypertrophy with normalization of BNP mRNA levels. Compensatory hypertrophy was not suppressed; therefore, ANP mRNA level, although decreased, was still beyond the normal level. The alpha1-receptor blockade slightly attenuated LV hypertrophy with a slight decrease in ANP mRNA levels. LV fibrosis was not prevented, and the BNP mRNA level was not decreased.

CONCLUSIONS

BNP gene expression is not enhanced by initial compensatory hypertrophy, but is enhanced by LV fibrosis and late stage progression of hypertrophy dependent on AT1R-mediated signaling pathway.

A case of successful fetal therapy for congenital chylothorax by intrapleural injection of OK-432

A 38-year-old multiparous woman was referred at 19 weeks' gestation because of hydrops fetalis. Ultrasonic examination revealed severe pleural effusion, ascites and skin edema. Detailed examination of the amniotic fluid, fetal blood and intrathoracic fluid led to a diagnosis of congenital fetal chylothorax. Repeated thoracocenteses were not effective in improving the hydrops fetalis. We introduced fetal treatment for the pleural effusion by an intrapleural injection of OK-432 at 23, 24 and 25 weeks' gestation. The pleural effusion was reduced by adhesion of the intrathoracic space and resulted in the delivery of a neonate who was healthy except for right renal dysfunction. Pulmonary hypoplasia was successfully prevented by OK-432.

Surgical results of skull base surgery for the treatment of head and neck malignancies involving skull base: multi-institutional studies on 143 cases in Japan

We analyzed 143 cases of skull base surgery collected from the eight institutions of the Study Group supported by the Grant-in-Aid for Cancer Research from the Ministry of Health and Welfare of Japan. Histologically, the most common type was squamous cell carcinoma (n = 78), which was followed by olfactory neuroblastoma (n = 16) and adenoid cystic carcinoma (n = 16). The most frequent surgical approach was frontal craniotomy (n = 66), followed by front-temporal craniotomy (n = 54) and infratemporal fossa approach (n = 8). For repair of dura matter, fascia lata was used in 37 cases. galeopericranial flap in 35 and temporal muscle fascia in 16. The 5-year survival rate by Kaplan-Meier method of nose and paranasal sinus carcinoma (n = 119) was 48%. As for histological classification, the survival rates were both 65%) in adenoid cystic carcinoma (n = 12) and bone soft tissue malignancy (n = 10), 62% in olfactory neuroblastoma (n = 16), 46% in squamous cell carcinoma (n = 62) and 33% in adenocarcinoma (n = 11). All the three cases of malignant melanoma died within 1 year, so we considered skull base surgery to be contraindicated for this disease. Complications were observed in 62 out of the 143 cases (43%); local infection was most frequent in 29 cases. liquorrhea in 18, abscess in 16, necrosis of the flap and meningitis in ten cases, DIC in four, rupture of the internal carotid artery in two and cerebral thrombosis in one. Death caused directly by surgery was in ten cases (7%). It is important that a multi-center registry be maintained to have a large enough database for comparison of results, and prognosis for each histological entity and further define the role of multidisciplinary treatment.

[A case of suspected pulmonary air embolism in endoscopic neurosurgery]

Sudden reduction in end-tidal PCO2 and SpO2 occurred during the endoscopic third ventriculostomy in a patient with hydrocephalus under general anesthesia. We suspect that it was caused by pulmonary air embolism. A 63-year-old female was scheduled for endoscopic third ventriculostomy under general anesthesia. Endoscopic manipulation caused hemorrhage from chorioid plexus 21 minutes after the procedure was begun, and intraventricular irrigation was performed to achieve hemostasis. In the subsequent 3 minutes, end-tidal PCO2 declined from 26 mmHg to 15 mmHg (PaCO2 39.6 mmHg), and SpO2 declined from 98% to 92% (PaO2 69.2 mmHg). Nitrous oxide was discontinued immediately because pulmonary air embolism was suspected and the oxygen concentration was increased to 100%. At the same time the surgical procedure was discontinued. After 15 minutes, end-tidal PCO2 recovered to 25 mmHg, and SpO2 recovered to 98% (PaO2 136.5 mmHg), and surgery was resumed. The patient recovered from anesthesia. The chest X-p at the end of operation, and pulmonary scintigraphy on the following day revealed no abnormal findings, but brain CT demonstrated a large quantity of air in both lateral ventricles.

Effect of carotid endarterectomy on chronic ocular ischemic syndrome due to internal carotid artery stenosis

OBJECTIVE

We evaluated the effect of carotid endarterectomy on chronic ocular ischemic syndrome due to internal carotid artery stenosis by use of data obtained from ophthalmic artery color Doppler flow imaging.

METHODS

We examined 11 patients with ocular ischemic syndrome due to internal carotid artery stenosis (>70% stenosis) who were being treated by carotid endarterectomy. Ophthalmic artery color Doppler flow imaging indicated ophthalmic artery flow direction and peak systolic flow velocity and was performed before and at 1 week, 1 month, and 3 months after surgery.

RESULTS

We assessed the ophthalmic arteries of 11 patients via color Doppler flow imaging. Before undergoing carotid endarterectomy, five patients showed reversed ophthalmic artery flow. In the other six patients who experienced antegrade ophthalmic artery flow, the average peak systolic flow velocity was 0.09 +/- 0.05 m/s (mean +/- standard deviation). Preoperative reversed flow resolved in each patient 1 week after undergoing surgery. All patients showed antegrade ophthalmic artery flow. The average peak systolic flow velocity in the patients who had preoperative antegrade flow rose significantly, to 0.21 +/- 0.14 m/s (P < 0.05). There was no significant change as compared with findings at 1 week after surgery. During the follow-up period (mean, 32.4 mo), no patients complained of recurrent visual symptoms. At the end of the study period, visual acuity had improved in five patients and had not worsened in the other six patients.

CONCLUSION

Carotid endarterectomy was effective for improving or preventing the progress of chronic ocular ischemia caused by internal carotid artery stenosis.

E2F regulates growth-dependent transcription of genes encoding both catalytic and regulatory subunits of mouse primase

DNA polymerase alpha-primase is one of the principal enzymes involved in eukaryotic chromosomal DNA replication. Mouse DNA polymerase alpha-primase consists of four subunits with molecular masses of 180, 68, 54 and 46 kDa. Protein and mRNA expression levels of the four subunits are up-regulated in a coordinated manner in response to growth stimulation. We have previously analysed the transcription of the 180 kDa (p180) and 68 kDa (p68) subunits, which form the DNA polymerase catalytic complex, and found that growth-dependent regulation of transcription of the mouse p180 and p68 genes is mediated by a common factor, E2F, while the basal transcription of the genes is regulated by different transcription factors. We characterized the transcriptional regulation of the 54 kDa (p54) and 46 kDa (p46) subunits, which form the DNA primase catalytic complex. We isolated genomic clones spanning the 5'-flanking regions of the p54 and p46 genes and showed, using transient expression and gel mobility shift assays, that the basal transcription of p54 is controlled by Sp1 and GA-binding protein, as is the basal transcription of the p180 gene. The basal transcription of p46 is controlled by unknown factor(s) which were bound to the upstream sequence. The variant E2F sites close to the transcription initiation sites of the p54 and p46 genes had no basal promoter activity, but were essential for the growth-dependent transcription of both genes. The promoter regions of the four subunits of mouse DNA polymerase d-primase complex share several common features. The coordinated transcription of all four subunits in response to growth stimulation appears to be controlled by E2F.

[Anesthetic management of two patients with polymyositis]

We report anesthetic experience of two patients suffering from polymyositis. The first case is a 56 year old woman who underwent tympanoplasty for cholesteatoma of the middle ear. Anesthesia was induced with thiopental and deepened with oxygen-nitrous oxide and sevoflurane. No muscle relaxant was used for endotracheal intubation and for maintaining anesthesia. Another is a 61 year old man who underwent open reduction and internal fixation for condyle fracture of the tibia. Epidural catheter was inserted at L 3-L 4. Epidural blockade was established with 2% mepivacaine, and sedation was achieved by intravenous midazolam. Concerning the anesthetic management of a patient with polymyositis, there are some informations on the appropriate use of muscle relaxants. It is generally believed that the patient is sensitive to nondepolarizing muscle relaxants and the use of antagonist drug (reversal) may cause muscle weakness, severe dysrhythmia, et al. Therefore we think it is appropriate to manage such a patient without muscle relaxants.

Evolving changes in Doppler mitral flow velocity pattern in rats with hypertensive hypertrophy

OBJECTIVES

The aim of our study was to explore evolving changes in a mitral flow velocity pattern (MFVP) and its hemodynamic and pathological correlates in hypertensive rats in an isolated diastolic heart failure model.

BACKGROUND

Development of left ventricular (LV) hypertrophy and concomitant diastolic dysfunction cause heart failure in hypertensive hearts even with normal systolic function; however, associated evolving change in MFVP is still unclear.

METHODS

Mitral flow velocity pattern was recorded every 2 weeks from 7 to 19 weeks in six hypertensive rats. Hemodynamic and pathological correlates of Doppler mitral flow indexes were examined as an additional part of the study using the hypertensive rats at the age of 13 weeks (compensatory stage, n = 7) and at 19 weeks (heart failure stage, n = 8).

RESULTS

Initial development of pressure overload LV hypertrophy resulted in a decrease in early diastolic filling wave (E), a reciprocal increase in the filling wave due to atrial contraction (A) and prolongation of deceleration time of E wave (relaxation abnormality pattern). These changes were associated with an increase in tau, an index of LV relaxation, but without a change in LV end-diastolic pressure. Transition to congestive heart failure caused an increase in E, a decrease in A and shortening of deceleration time. These changes were not associated with further increase in tau but with elevation of LV end-diastolic pressure, reflecting marked LV hypertrophy and myocardial fibrosis.

CONCLUSIONS

Development of pressure overload LV hypertrophy is associated with evolving changes in MFVP from normal to relaxation abnormality pattern and, in turn, to pseudonormalized to restrictive pattern. Analysis of MFVP may be useful to follow not only functional but also constitutional changes of the myocardium in hypertensive hearts.

Calcineurin inhibitor attenuates left ventricular hypertrophy, leading to prevention of heart failure in hypertensive rats

BACKGROUND

There is controversy regarding the contribution of calcineurin activation to the development of pressure-overload left ventricular (LV) hypertrophy and heart failure. The aim of this study was to explore whether the inhibition of calcineurin may prevent the transition to heart failure in hypertensive rats and, if so, to clarify in which developmental stage of LV hypertrophy calcineurin plays a key role.

METHODS AND RESULTS

Dahl salt-sensitive rats placed on an 8% NaCl diet from the age of 7 weeks (hypertensive rats) were randomized to no treatment (n=6) or treatment with the calcineurin inhibitor FK506 (1 mg x kg(-1) x d(-1)) from 8 weeks (FKE, n=7) or from 17 weeks (FKL, n=7). Rats placed on a 0.3% NaCl diet were defined as control rats (n=6). The administration of FK506 from 8 weeks attenuated, although it did not block, LV hypertrophy observed in the untreated rats and prevented the transition to heart failure. The development of LV fibrosis, however, was not attenuated by the administration of FK506 from 8 weeks. The administration of FK506 from 17 weeks brought no benefit for cardiac remodeling or LV function and failed to prevent heart failure.

CONCLUSIONS

Calcineurin inhibition, if started from the initial stage of pressure overload, attenuated the development of LV hypertrophy without any effect on LV fibrosis and prevented the transition to heart failure. The activation of calcineurin is involved in the development of LV hypertrophy but not of LV fibrosis, and this involvement may be crucial at the initial stage.

Roles of renin-angiotensin and endothelin systems in development of diastolic heart failure in hypertensive hearts

OBJECTIVE

Although interest in diastolic heart failure is growing because of its clinical frequency, little is known about this type of heart failure. Our laboratory recently developed a diastolic heart failure model using Dahl salt-sensitive rat. In this model, gene expression of angiotensin-converting enzyme and endothelin (ET) system in the left ventricle was enhanced at heart failure stage without downregulation of angiotensin type 1a receptor mRNA level. However, the roles of these humoral systems in the transition to diastolic failure remain unclear.

METHODS

Subdepressor doses of angiotensin II type 1 (AT1) receptor and ET type A (ETA) receptor antagonists were administered in this model just after onset of hypertension, and their effects were investigated.

RESULTS

Neither AT1 nor ETA receptor blockade inhibited the early (13 weeks) compensatory left ventricular (LV) hypertrophy. This form of compensatory hypertrophy is associated with subnormal LV end-systolic stress, which was normalized by AT1 receptor blockade but not by ETA receptor blockade. Progression of LV hypertrophy and fibrosis and transition to heart failure (19 weeks) in the untreated rats were prevented by both antagonists, resulting in normalization of LV end-diastolic pressure and lung weight. AT1 receptor blockade, but not ETA receptor blockade, normalized time constant of LV relaxation. Enhanced gene expression for ET system in the left ventricle observed in the untreated rats was suppressed with AT1 receptor antagonist administration. ETA receptor blockade slightly but significantly elevated the AT1a receptor mRNA level as compared with the untreated rats.

CONCLUSIONS

RAS and ET system contribute to the transition to diastolic heart failure through the development of excessive hypertrophy and ventricular fibrosis in hypertensive heart diseases, however, neither RAS nor ET system is mandatory for normal compensation for pressure overload. RAS apparently causes such diastolic effects at least partly through the ET system.

[Sitting position in the neurosurgery: the results of a questionnaire sent to neurosurgeons of medical colleges]

We analyzed questionnaire on the sitting position among neurosurgeons. We sent questionnaire to 80 medical colleges in Japan and obtained response from 61 universities (76.3%). The sitting position surgery was performed in 7 institutions (11.5%) and was not in other 54 (88.5%). The first reason for not adopting the sitting position was "other position was good enough to perform the surgery" (44 institutions, 81%). This reason exceeded "objection from the anesthesiologist" (17 institutions, 31%). Twenty institutions (33%) adopted or wished to perform the surgery in sitting position, indicating that neurosurgeons still are interest in performing the sitting position surgery. But 6 institutions adopting the sitting position predicted that the sitting position would diminish in the future, and the sitting position surgery would decrease in number in Japan.

Use of echocardiography for predicting myocardial viability in patients with reperfused anterior wall myocardial infarction

Dobutamine stress echocardiography (DSE), myocardial contrast echocardiography (MCE), and ultrasonic tissue characterization with integrated backscatter are useful methods for assessing myocardial viability in acute myocardial infarction. In this study, we compared the potential of 3 methods for predicting myocardial viability in 38 patients with reperfused anterior wall acute myocardial infarction. We performed MCE shortly after coronary reperfusion with an intracoronary injection of microbubbles. We recorded 2-dimensional integrated backscatter images at rest and, then, performed low-dose (10 microg/kg/min) DSE 3 days later. In integrated backscatter images, we placed the region of interest in the midwall of the myocardial segment to reconstruct the cyclic variation of myocardial integrated backscatter. The myocardial segment was judged viable when it showed active contraction 3 months later. Among 74 segments analyzed, 34 were judged viable. Presence of contractile response during DSE predicted segmental viability with 91% sensitivity and 78% specificity. Intense and homogenous contrast enhancement with MCE predicted viability with 82% sensitivity and 73% specificity. The presence of synchronous contraction of cyclic variation predicted myocardial viability with 79% sensitivity and 83% specificity. There were no differences in sensitivity and specificity among the 3 methods. Thus, MCE and ultrasonic tissue characterization can predict myocardial viability as accurately as DSE in patients with acute myocardial infarction. The logistics of the methods may determine clinical application.

[Intravenous contrast echocardiography]

Intravenous contrast echocardiography has become possible in Japan because of the release of the commercially available contrast agent, Levovist. Intravenous administration of Levovist satisfactorily stains the left ventricular cavity, which makes it possible to clearly delineate the endocardial border. Clear delineation of the endocardial border provides easy and accurate measurement of left ventricular dimension and wall thickness, and wall motion abnormalities can be easily and accurately judged, too. Another benefit of intravenous contrast echocardiography is the assessment of myocardial perfusion. Our preliminary experimental and clinical experiences showed the possibility of myocardial staining with intravenous contrast echocardiography. Impressive myocardial staining is obtainable with the combined use of intermittent and contrast harmonic power Doppler imaging. In order to obtain reproducible and clear myocardial contrast images, we have to pay attention to how to inject contrast and settings of ultrasound equipment, i.e., mechanical index, gain setting, depth of focus point, and pulse repetition frequency, artifacts. In the near future, a lot of issues should be standardized to make it possible to compare myocardial contrast echo studies.

Use of the abdominal wall fat index determined ultrasonographically for assessing the risk of post-operative pulmonary embolism

OBJECTIVE

To assess the usefulness of the abdominal wall fat index (AFI) for predicting pulmonary embolism (PE) after gynecologic surgery.

METHOD

The subjects were 115 female patients who underwent laparotomy for gynecologic disease. They were divided into low-dose heparin therapy (n=28) and control, without heparin (n=87) groups. The AFI ratio of the maximum preperitoneal fat thickness to the minimum subcutaneous fat thickness was determined using ultrasonography.

RESULT

Post-operative PE occurred in four control patients. If the cut-off value of the AFI for predicting PE development was set at more than or equal to 0.85, the sensitivity was 1.00 and the specificity was 0.60 (P=0.03). If we restricted the criteria, and set the cut-off value of the AFI to more than or equal to 0.85 in patients with hypertension [systolic blood pressure (BP)>/=140 mmHg, diastolic BP>/=90 mmHg or patients were taking antihypertensive medication], the sensitivity and specificity were 0. 75 and 0.92, respectively (P=0.001).

CONCLUSION

Visceral fat obesity is a risk factor for PE after gynecologic surgery, and the AFI is useful for predicting PE and for whom post-operative low-dose heparin therapy may be indicated.

Sex chromosomal analysis of spermatozoa from infertile men using fluorescence in situ hybridization

PURPOSE

To confirm an association between male infertility and chromosome aberrations of spermatozoa, we demonstrated the frequency of numerical abnormalities of spermatozoa from infertile men with abnormal semen parameters compared with fertile controls.

METHOD

Sperm cells from 10 infertile patients were investigated for disomy rates of sex chromosomes and chromosome 18 and diploidy by fluorescence in situ hybridization (FISH). All patients showed oligoasthenozoospermia with sperm counts 3-20 x 10(6)/ml and motile rates 0-40%.

RESULTS

Regarding XY disomy, a significantly higher frequency was found in 8 of 10 patients as compared to normal fertile men. The disomy rates of chromosome 18, XX, YY, and diploidy rate were not increased.

CONCLUSIONS

There is an association between male infertility and embryo with aneuploidy of sex chromosomes. Counseling about possible genetic risks should be provided to the infertile couples planning assisted reproduction treatment.

Effects of bypass on ocular ischaemic syndrome caused by reversed flow in the ophthalmic artery

Superficial temporal to middle cerebral artery bypass was useful for ocular ischaemic syndrome caused by reversed flow in the ophthalmic artery as shown by ophthalmic-artery colour doppler flow imaging.

Early temporal changes in coronary flow velocity patterns in patients with acute myocardial infarction demonstrating the "no-reflow" phenomenon

Coronary flow velocity pattern in patients with acute myocardial infarction demonstrating no-reflow phenomenon is characterized with early systolic retrograde flow and rapid deceleration of diastolic flow velocity. In this study, we investigated the early temporal changes in microvascular function in patients with the no-reflow phenomenon. Among 144 patients with a first acute myocardial infarction, 33 exhibited sizable no-reflow phenomenon after coronary reperfusion with myocardial contrast echocardiography. We assessed temporal changes in coronary flow velocity patterns with the Doppler guidewire. The early systolic retrograde flow was observed < or = 10 seconds after reperfusion in 16 patients (group A) or later in 17 patients (331 +/- 327 seconds, group B). Diastolic deceleration rate was higher in group A than in group B at 1 minute after reperfusion. It gradually increased in group B and showed comparable value to group A 10 minutes later. Group A had longer elapsed time from symptom onset to reperfusion and a greater number of infarct Q waves before reperfusion than group B (14 +/- 13 vs 5 +/- 2 hours, p <0.01; and 3 +/- 2 vs 2 +/- 1, p <0.02). In contrast, the incidence of transient ST reelevation shortly after reperfusion was higher in group B (76% vs 25%, p <0.01). Thus, the characteristic coronary flow velocity pattern is either established at the moment of coronary reperfusion or progresses thereafter in patients with no-reflow phenomenon. This suggests different mechanisms of developing ischemic microvascular injury.

[Anesthetic management of a patient with Osler-Weber-Randu disease]

Osler-Weber-Randu disease (Osler disease) is an autosomal dominant disease, sometimes known as hereditary hemorrhagic telangiectasia with its family history. It is not a popular disease and approximately seventy families are known as inheritance lineage in Japan. We experienced anesthetic management of a 49-yr-old woman with Osler disease. She was diagnosed to have the brain abscess following fever and clouding of consciousness for several days and was scheduled for the removal of the abscess. A chest X-ray revealed pulmonary arteriovenous fistula in the right middle lung field. The patient had had life threatening frequent massive bleeding from her nose and/or stomach for the past several years. Her brother and children also had the same symptoms. In addition to Osler disease, the patient had the prolonged coagulation time that was supposed to the due to chronic liver disease. Therefore, fresh frozen plasma (5 units) and platelet concentrates (10 units) were infused during the surgery. Intraoperative blood loss was about 700 grams. We had no difficulties in management of bleeding and respiratory controls during anesthesia.

Comparison of predictive value for colorectal cancer in subjects with and without rectal bleeding

BACKGROUND/AIMS

To clarify the association between a sign of rectal bleeding and colorectal cancer, and to reveal the relationship of rectal bleeding to the results of an immunochemical fecal occult blood test.

METHODOLOGY

In a population-based cross sectional study, 30,138 subjects who received immunochemical fecal occult blood screening with a 2-day method were divided into two groups, according to the results of a questionnaire on a sign of rectal bleeding, and the positivity rate of an immunochemical occult blood test as well as the predictive value for colorectal cancer were compared in the two groups.

RESULTS

The fecal occult blood test was positive in 8.8% of subjects with rectal bleeding and in 6.0% of subjects without rectal bleeding, and the predictive value was 6.4% and 3.3% in subjects with and without rectal bleeding, respectively, showing a significant difference in the positivity rate (p<0.001) as well as the predictive value (p<0.05) between these two groups.

CONCLUSIONS

These findings indicate that there are positive relations between the subjects with rectal bleeding presentation and colorectal cancer, and a sign of rectal bleeding and the results of an immunochemical fecal occult blood test.

Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction

OBJECTIVES

We assessed whether the intravenous administration of nicorandil, an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts beneficial effect on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI).

BACKGROUND

Experimental studies documented that ATP-sensitive K+ channel opener exerts cardioprotection after prolonged ischemia.

METHODS

We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41). All patients received successful coronary angioplasty within 12 h after the symptom onset and underwent myocardial contrast echcardiography (MCE) with the intracoronary injection of sonicated microbubbles. In the nicorandil group, we injected 4 mg of nicorandil followed by the infusion at 6 mg/h for 24 h and by oral nicorandil (15 mg/day).

RESULTS

The improvement in regional left ventricular function, wall motion score and regional wall motion was significantly better in the nicorandil group then in the control group. Intractable congestive heart failure, malignant ventricular arrhythmia and pericardial effusion were more frequently found in the control group than in the nicorandil group (15% vs. 37%, 5% vs. 20% and 8% vs. 37%, p < 0.05, respectively). The frequency of sizable MCE no reflow phenomenon was significantly lower in the nicorandil group than in the control group (15% vs. 33%, p < 0.05).

CONCLUSIONS

Intravenous nicorandil in conjunction with coronary angioplasty is associated with better functional and clinical outcomes compared to angioplasty alone in patients with an anterior AMI. Myocardial contrast echocardiography findings imply that an improvement in microvascular function with nicorandil may be attributable to this better outcome.

[The effect of epidural anesthesia on reducing blood loss during upper abdominal surgery]

We examined the advantage of the combined epidural anesthesia with general anesthesia for the upper abdominal surgery One hundred and thirty-five gastric cancer patients were subjected to the study. They were divided into four groups. Group A (n = 46) and B (n = 44) received distal gastrectomy, and group C (n = 27) and D (n = 18) received total gastrectomy. In group A and C, anesthesia was maintained with combined epidural and general anesthesia. In group B and D, only general anesthesia was administered. We compared group A versus B and groups C versus D. The parameters for the comparisons were intraoperative blood loss, averaged mean blood pressure, surgical operation time, etc. The patient background was not different between group A and B, and also between group C and D. The blood loss and mean blood pressure were significantly lower in groups A and C than in groups B and D. But there was no correlation between the blood loss and mean blood pressure. The results suggest that the fall of the mean blood pressure is one of the causes of reduced blood loss, but the causes may include other complicated parameters. We conclude that the combined use of epidural anesthesia with general anesthesia is useful for reducing the amount of blood loss for upper abdominal surgery.

Antecedent angina pectoris as a predictor of better functional and clinical outcomes in patients with an inferior wall acute myocardial infarction

We examined whether angina pectoris (AP) occurring shortly before the onset of acute myocardial infarction (AMI) can render the right ventricle and the conducting tissue resistant to ischemia in 75 patients with an inferior wall AMI. Each patient had total occlusion in the proximal right coronary artery and underwent successful coronary angioplasty < or =24 hours from the onset. We divided patients into 2 groups based on presence or absence of antecedent AP < or =24 hours before the system onset: group 1 (absent) = 57 patients; group 2 (present) = 18 patients. Collateral circulation was more frequently observed in group 2 than in group 1 (group 1 vs 2, 28% vs 61%, p <0.01). Elevation in ST segment > or =1 mm in lead V4R, hemodynamic right ventricular dysfunction, and frequency of high-degree heart block were more frequent in group 1 than in group 2 (75% vs 44%, 79% vs 39%, 53% vs 11%, p <0.05, respectively). Multivariate analysis demonstrated that antecedent AP is the only factor related to these complications. Thus, episodes of AP occurring shortly before onset may restrain development of ischemic damage of the right ventricle and conducting tissue, and are associated with better clinical and functional outcomes among patients with an inferior wall AMI.

[Propofol combined with epidural anesthesia for a patient complicated with myelodysplastic syndrome (MDS)]

A 55 year-old-female with myelodysplastic syndrome (MDS) underwent hemi-colectomy. We planned to avoid the use of nitrous oxide, because of its myelo suppressive effects. Therefore, we maintained the anesthesia with propofol combined with epidural anesthesia. After the surgical operation, the patient developed no hematological complications.

[Effect of the continuous epidural buprenorphine injection in patients after lower extremity arthroplasty]

We studied the analgesic effects of continuous epidural injection of buprenorphine in patients after lower extremity arthroplasty. In these patients anesthesia was maintained only with lumbar epidural anesthesia with 2% mepivacaine. We employed a balloon type continuous infuser (DIB Catheter, 40 ml.day-1) for postoperative analgesia for twenty-four hours. The patients were classified into three groups according to the method of buprenorphine injection and the content of DIB Catheter. First group (group A ; N = 37) received buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. Next group (group B ; N = 27) received bolus injection of buprenorphine (0.2 mg) for the first additional epidural injection of local anesthetic and received continuous injection of buprenorphine (0.2 mg) with 0.25% bupivacaine (40 ml) for twenty-four hours. The last group (Group C ; N = 40) also received bolus injection of buprenorphine as in group B, but received continuous buprenorphine infusion with normal saline instead of local anesthetics. The analgesic effect was determined by the postoperative usage of other analgesics (NSAID or pentazocine) by request of patients. In twenty-four hours, the numbers of patients who did not request other analgesics were 6 (Group A. 16%), 9 (Group B. 33%) and 19 (Group C. 48%), respectively. In Group A, 18 patients requested analgesics, but only 8 patients requested in Group C. It was effective for the postoperative analgesia to use the continuous epidural injection with DIB Catheter for patients after lower extremity arthroplasty. It was necessary to give a bolus injection of buprenorphine before the end of surgery for sufficient analgesia, but it was not necessary to add local anesthetics in the content of DIB Catheter.

Ultrasonic tissue characterization predicts myocardial viability in early stage of reperfused acute myocardial infarction

BACKGROUND

The aim of the present study was to characterize temporal changes in cyclic variation of ultrasonic integrated backscatter (IBS), which reflects intrinsic contractile performance, in patients with reperfused acute myocardial infarction (AMI) and to elucidate the clinical value of tissue characterization in predicting myocardial viability.

METHODS AND RESULTS

We recorded short-axis IBS images before and 3, 7, and 21 days after reperfusion in 26 patients with AMI and obtained the cyclic variation of IBS in the normal and infarct zones. When cyclic variation showed synchrony and asynchrony, we expressed its magnitude as positive and negative values, respectively, called the phase-corrected magnitude. We also measured average wall motion score (dyskinesis, 4; normal, 0) of the infarct segments. The phase-corrected magnitude was lower in the infarct zone than in the normal zone before reperfusion (0.3+/-2.5 versus 5.2+/-1.7 dB, P<.05). At day 3, the phase-corrected magnitude increased by 2.1+/-2.6 dB despite no improvement in wall motion. Improvement in wall motion was observed only at day 21. The patients with the phase-corrected magnitude of > or =2.0 dB at day 3 showed significantly lower wall motion score at day 21 than did the other patients (1.7+/-0.6 versus 2.4+/-0.5, P<.01).

CONCLUSIONS

In patients with AMI, cyclic variation of IBS is blunted during ischemia but recovers much faster after reperfusion than the improvement in wall motion. The greater phase-corrected magnitude at day 3 may be a predictor of better functional improvement.

A new pseudo-peptide of Arg-Gly-Asp (RGD) with inhibitory effect on tumor metastasis and enzymatic degradation of extracellular matrix

A series of pseudo-peptide analogs of the Arg-Gly-Asp (RGD) sequence of fibronectin have been synthesized, and their anti-metastatic effects in mice and inhibitory effects on tumor cell invasion in vitro have been examined. The partially modified retro pseudo-peptide of RGD, Rrev-COCH2CO-D (FC-63), was more effective in inhibiting tumor metastasis than the original RGDS peptide. Replacement of the malonyl moiety of FC-63 with a carboxyethylene linkage (Rrev-COCH2CH2-D, FC-303 ) achieved more potent inhibition of lung metastasis of melanoma cells than FC-63. Among the analogs, FC-336, a p-xylylendiamine derivative having two FC-303 moieties, showed the most potent inhibitory effect on experimental lung metastasis produced by i.v. co-injection with B16-BL6 melanoma or colon 26 M3.1 cells in a dose-dependent manner. Multiple administrations of FC-336 after tumor inoculation also showed efficient therapeutic potency against spontaneous lung metastasis of B16-BL6 melanoma in mice. Furthermore, FC-336 effectively inhibited the invasion, migration and adhesion of tumor cells in vitro, but its inhibitory effects were not more than those of RGDS peptide. Zymography analysis revealed that FC-336 inhibited the degradation of gelatin substrate by matrix metalloproteinases (MMPs) produced by tumor cells, while the RGDS peptide did not affect the enzymatic degradation. These findings indicate that the pseudo-peptides of the RGD sequence, possessing the inhibitory property of the degradation by MMPs differently from original RGD-containing peptides, may be advantageous and useful in preventing tumor metastasis.

Beneficial effect of intracoronary verapamil on microvascular and myocardial salvage in patients with acute myocardial infarction

OBJECTIVES

We assessed the acute effect of intracoronary injection of verapamil on microvascular function after primary percutaneous translumanal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) with myocardial contrast echocardiography (MCE) in relation to functional outcomes.

BACKGROUND

Recent clinical studies have documented the potential of verapamil for possible increase in coronary blood flow after primary PTCA.

METHODS

Forty patients with a first AMI were randomly assigned to the verapamil group (n = 20) or the control group (n = 20). In the verapamil group, verapamil (0.5 mg) was injected into the infarct-related artery shortly after PTCA, followed by the oral administration. We performed MCE with an intracoronary injection of sonicated microbubbles before and after verapamil. To assess microvascular integrity, we determined the baseline-subtracted peak intensity in the risk area and the ratio of the no reflow zone plus the low reflow zone to the risk area (low reflow ratio). We determined the average wall motion score (dyskinesia/akinesia = 3; normal = 0) in the risk area on the day of AMI and a mean of 24 days later.

RESULTS

The low reflow zone was observed shortly after PTCA in 14 verapamil group patients, and the low reflow ratio decreased after verapamil (0.39 +/- 0.23 vs. 0.29 +/- 0.17 [mean +/- SD], p < 0.05). Peak intensity significantly (p < 0.05) increased from 6 +/- 5 to 12 +/- 6 after verapamil. The reduction in wall motion score from the acute (day -1) to the late stage (day -24) was significantly greater in the verapamil group than in the control group (0.7 +/- 0.8 vs. 0.2 +/- 1.3, respectively, p < 0.05).

CONCLUSIONS

Intracoronary administration of verapamil after primary PTCA can attenuate microvascular dysfunction and thereby augment myocardial blood flow in patients with AMI, leading to better functional outcome than with PTCA alone.

Enrichment of oligo(dG).oligo(dC)-containing fragments from human genomic DNA by Mg 2+-dependent triplex affinity capture

Oligo(dG).oligo(dC)- or short poly(dG).poly(dC)-containing fragments were enriched and cloned by means of Mg2+-dependent triplex affinity capture and subsequent cloning procedures. A library constructed after three cycles of enrichment showed that approximately 80% of the clones in the supercoiled form formed a complex with labeled oligonucleotide (dG)34. However, while the rest of the clones retained the ability to form a complex (type I clones), 90.9% failed to form a complex when they were linearized. This group of DNA was abundant in the genomic DNA, although it showed only approximately 3-fold enrichment by one cycle of affinity capture. This group was further classified into two species (types II and III) based on complex formation ability after phenol extraction. Type II clones retained the complex formation ability after treatment, while the human telomere [(TTAGGG)n] and telomere-like [(TGGAA)n] or [(TGGAG)n] sequences belonging to type III clones did not. Serial deletion experiments and the binding assays using oligonucleotides confirmed that the repetitive units containing T(G)nT ( n = 3-5) tracts or (G)n-motifs (n >/= 3) were the sites of complex formation for type II and III clones. On the other hand, type I clones contained poly(dG).poly(dC) tracts at least 10 nt long, and DNase I-footprinting analysis indicated that these tracts were the sites of complex formation.

[Optic neuritis and measles infection]

Optic neuritis has been reported as a complication of measles encephalitis. This resembles to parainfectious optic neuritis following other virus infections. We mentioned pathology, therapy of this disease, and summarized our previous cases. Intravenous methylpredonisolone treatment is effective from our experience.

An approach to the detection of autonomic neuropathy by use of signal-averaged electrocardiography

The beat-to-beat variation of PR interval, which is thought to be a reflection of autonomic nervous system, is difficult to measure with accuracy because the variation is too subtle. However, R wave amplitude in the P wave triggered SAECG is easily attenuated in comparison to that in the R wave triggered SAECG, which might be due to PR interval fluctuation. To determine whether autonomic neuropathy could be detected by use of SAECG, two types of SAECGs triggered by P and R waves were recorded in 23 diabetics with autonomic neuropathy and 41 age matched controls. The peak voltage of filtered QRS complex was measured in the R wave and P wave triggered SAECGs. Percent attenuation of the filtered QRS voltage was calculated by dividing the difference between the voltages in the R wave and P wave triggered SAECGs by the voltage in R wave triggered SAECG. The percent attenuation of filtered QRS voltage was significantly smaller in diabetics with autonomic neuropathy than controls (4.6% +/- 4.9% vs 16.3% +/- 15.0%; P < 0.001). These results suggest that the degree of attenuation of filtered QRS voltage in the P wave triggered SAECG would be useful for the detection of autonomic neuropathy.

Liposomal Arg-Gly-Asp analogs effectively inhibit metastatic B16 melanoma colonization in murine lungs

Analogs of a synthetic peptide having the L-arginine-L-glycine-L-aspartic acid (RGD) sequence have been found to decrease metastatic colonization. To enhance the metastasis-suppressing efficacy of these analogs, we sought to stabilize these analogs and to prolong their circulation time by incorporating them into a liposomal formulation. Various structures of RGD analogs grafted to hydrophobic groups were synthesized and then incorporated into liposomes. Liposomes composed of distearoylphosphatidylcholine, cholesterol, dipalmitoylphosphatidylglycerol and appropriate RGD analogs were injected intravenously along with B16BL6 murine melanoma cells into mice. Liposomal RGD (0.6 mumol of the analog equivalent to ca. 200 micrograms RGD peptides) inhibited lung colonization up to 76%. This dose is an order of magnitude lower than that for comparable inhibition reported for free RGD. Multi-dose administration of liposomal RGD (0.15 mumol of the analog) also inhibited the spontaneous lung metastasis of cells from a primary tumor site of B16BL6 cells subcutaneously implanted into the footpad of mice. Taken together, our data indicate that liposomal RGD may serve as a useful anti-metastatic agent.

Construction of a human genomic library of clones containing poly(dG-dA).poly(dT-dC) tracts by Mg(2+)-dependent triplex affinity capture. DNA polymorphism associated with the tracts

Microsatellite DNA is a useful tool for detecting DNA polymorphisms among species or individuals, especially those among closely related individuals. We constructed a library of clones that contained poly(dG-dA).poly(dT-dC) tracts from human genomic DNA by Mg(2+)-dependent triplex DNA formation. Examination of triplex DNA formation in the presence of various metal ions Mg2+, Mn2+, or Zn2+ revealed that the procedure worked best in the presence of Mg2+. Affinity enrichment was performed with AluI-digested chromosomal DNA mixed with biotinylated (dG-dA)17 in the presence of Mg2+. A library constructed after three cycles of affinity enrichment showed that over 80% of the clones contained at least one poly(dG-dA).poly(dT-dC) tract. Most of them contained a perfect (dG-dA)n repeat 30-84 base pairs in length, while some contained variants such as (dC-dT)10-(dC)-(dC-dT)9. Using the clones from the library as a probe, we detected DNA polymorphisms associated with the repeat length of the tracts in the Japanese population. We also detected a microsatellite instability among the tracts in a cancer tissue sample.

Effect of acoustic overstimulation on the hydropic ear

The effect of acoustic overstimulation (2 kHz pure tone) on the compound action potential (CAP) threshold was investigated at frequencies ranging from 2 to 16 kHz using albino guinea pigs, both normal and with experimentally induced endolymphatic hydrops. The hydropic ears were less susceptible to acoustic overstimulation than the normal ears. As the CAP threshold was raised, the frequency exhibiting the greatest CAP threshold shift increased in both animal groups. The tendency was more noticeable in the hydropic ears than in the normal ears. These results are discussed from the aspect of cochlear hydrodynamics.

Effects of superficial temporal to middle cerebral artery bypass for ischaemic retinopathy due to internal carotid artery occlusion/stenosis

The effects of superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis for retinopathy is discussed and analysed in 19 cases of occlusive internal carotid artery disease (4 with stenosis and 15 with occlusion) according to Doppler sonography (DS) of the retinal artery, optic fundi and visual impairment symptoms. Preoperatively, all cases showed abnormal DS findings (stenosis patterns in 2 cases and the reversed flow patterns in 17 cases). All cases showed ischaemic changes of the optic fundi. Visual symptoms were amaurosis fugax in 2 cases, decline of visual acuity in 13 cases and both in 4 cases. At one month after the bypass, two stenosis pattern cases showed almost normal DS findings. In the 17 reversed flow pattern cases, 13 cases had a marked improvement of the reversed flow. The ischaemic changes of the optic fundi were ameliorated in 12 cases. In the follow-up stage, greater improvement in the DS findings and the optic fundi could be seen in all cases. In all cases worsening of the visual acuity was prevented, and in some cases the decreased visual acuity improved. The above improvements correlated well with the improvement of DS findings. It is believed that this procedure should be performed to prevent and improve ischaemic retinopathy caused by ischaemic ICA lesion.

Enrichment of human DNAs that flank poly(dA).poly(dT) tracts by triplex DNA formation

Human DNA fragments which contain poly(dA).poly(dT) tracts and their immediate flanking regions were enriched by means of triplex DNA formation. Human DNA fragments were mixed with biotinylated (dT)34 in the presence of Mg2+ and the triplex DNA [(dT)34.poly(dA).poly(dT)] was adsorbed onto streptavidin-coated magnetic beads and the DNA fragments which formed triplexes were eluted from the beads with a buffer containing EDTA. A control experiment using a plasmid with a poly(dA).poly(dT) tract indicated that DNA fragments with the tract could be enriched over 60-fold after one cycle of the treatment. After PCR amplification, the sample was subjected to the next cycle of the affinity enrichment. After four cycles, we obtained a human genomic DNA library of clones with inserts ranging from 500 to 1000 bp among which 86% had at least one poly(dA).poly(dT) tract. No less than 60% of the clones were close or distant members of the Alu family. Sequence determination of 25 clones revealed that the length of the poly(dA).poly(dT) tracts was 14 to 37 (average 28) bp and that they were located close to either end of the fragments. While 15 clones were identified as Alu family homologues and one as a human L1 family member, nine clones were of unknown origin. None of these nine clones were a highly repeated sequence nor a part of transcriptionally active regions.

Chronic ocular ischemia associated with the Eisenmenger's syndrome

We studied the ocular findings of two adult patients with the Eisenmenger's syndrome who had atrial septal defects that were diagnosed before the age of 10 years but not operated on and pulmonary hypertension. Both eyes of these patients showed microaneurysms, multiple small blot hemorrhages, or capillary dilation in the temporal peripheral fundus. Multiple microaneurysms and retinal collaterals were confirmed by fluorescein angiography. One of the patients developed bilateral rubeosis iridis with slow progression. These retinal lesions and the rubeosis iridis are probably related to chronic ocular ischemia caused by chronic systemic hypoxia.

Inhibition of tumor metastasis by Arg-Gly-Asp-Ser (RGDS) peptide conjugated with sulfated chitin derivative, SCM-chitin-RGDS

We have synthesized a new compound in which Arg-Gly-Asp-Ser (RGDS) was conjugated with 6-O-sulfated and 6-O-carboxymethyl-chitin (SCM-chitin), i.e. SCM-chitin-RGDS, and tested the inhibitory effect on lung and liver metastases of three different types of tumors in mice. SCM-chitin-RGDS was more effective for the inhibition of liver metastasis of L5178Y-ML25 lymphoma and lung metastases of colon 26 M3.1 cells than SCM-chitin, RGDS or their mixture. GRGDS peptide, however, required a higher dose (3000 micrograms) to obtain a sufficiently antimetastatic effect. Intermittent i.v. administration of SCM-chitin-RGDS before or after the i.v. inoculation of L5178Y-ML25 cells caused significant inhibition of liver metastasis as compared with the multiple administration of RGDS, SCM-chitin or untreated control. Co-injection of lymphoma cells with SCM-chitin-RGDS or multiple treatment of SCM-chitin-RGDS after tumor inoculation showed significantly enhanced survival rate. SCM-chitin-RGDS also showed the spontaneous lung metastasis produced by intrafootpad injection of B16-BL6 melanoma cells by the multiple i.v. administrations. These results demonstrate that the conjugation of RGDS peptide with SCM-chitin led to augmentation of therapeutic potential to cancer metastasis, thus implying an importance of the conjugation of cell-adhesive RGDS peptide with structurally heparin-like SCM-chitin, which possess binding ability to the heparin-binding domain of fibronectin or laminin and extremely low anticoagulant properties.

Variability of diastolic paradoxical jet flow in a patient with hypertrophic cardiomyopathy with midventricular obstruction: dissociation between systolic and diastolic intracavitary flow dynamics

Variability of paradoxical jet flow in a case of hypertrophic cardiomyopathy with midventricular obstruction was examined. Propranolol decreased both peak diastolic paradoxical jet flow velocity and peak systolic velocity at the narrowing portion. Nitroglycerin decreased peak diastolic paradoxical jet flow velocity with an increase in peak systolic velocity at the narrowing portion. Thus the diastolic paradoxical jet flow is dynamic as well as the abnormal systolic flow; however, changes in these abnormal flow dynamics may not be necessarily in the same direction. Doppler echocardiography should be useful in assessing effects of interventions on the flow dynamics in patients with hypertrophic cardiomyopathy with midventricular obstruction.

Intracellular HRP study of nociceptive neurons within the ventrobasal complex of the cat thalamus

Locations and morphological characteristics of nociceptive specific (NS) and wide dynamic range (WDR) neurons of the ventrobasal (VB) thalamic complex were studied using an intracellular HRP injection technique in cats anesthetized with urethane and chloralose. Both NS and WDR neurons were found within the marginal zone of the VB complex. Their somata were confined to the VB complex, but dendrites were extended into the structures of the thalamus surrounding the VB complex. NS neurons were found in the caudal part of the VB complex, whereas WDR neurons were found more rostrally. Examinations of their locations within the marginal zone of the VB complex confirmed the somatotopic organization, as found previously. We also confirmed the previous reports that there are 3 different types of low-threshold mechanoreceptive (LTM) neurons within the VB complex. They are type I, type II and type III neurons. Both NS and WDR neurons were either type I or type II neurons. Obvious morphological differences were not found between LTM neurons and two classes of nociceptive VB neurons investigated.

The effect of crossed olivo-cochlear bundle stimulation on acoustic trauma

To investigate whether the crossed olivo-cochlear bundle (COCB) functions in a protective manner, albino guinea pigs were exposed to sounds of varying intensity (110-130 dB SPL, 3-30 min) with or without electric stimulation of COCB, and the threshold shifts of the compound action potential (CAP) were examined. A statistically significant protective effect was observed in animals exposed to stimuli of intermediate intensity which induce threshold shifts of 50 to 55 dB on average. No protective effect was observed in the groups exposed to greater or milder stimuli. These results are discussed in the light of the available literature.

Trigeminal nociceptive neurons in the subnucleus reticularis ventralis. I. Response properties and afferent connections

Trigeminal nociceptive neurons within the subnucleus reticularis ventralis medullae oblongatae (SRV), which lies ventral to the trigeminal subnucleus caudalis and subnucleus reticularis dorsalis medullae oblongatae, were studied in urethane/chloralose-anesthetized cats and monkeys. These neurons were called 'SRV neurons'. They were almost regularly excited by pressure to the ipsilateral cornea or to both corneas at a strength well above the human corneal pain threshold. Most of them were activated by noxious mechanical stimulation of the pinna, face and/or tongue. A significant fraction of SRV units was responsive to tapping of the ipsilateral dorsum of the nose and/or electrical stimulation of tooth pulp afferents. Evidence was obtained that responses to tapping of the dorsum of the nose were due to mechanical distortion of the nasal mucosa. Intracellular injection of HRP into SRV neurons demonstrated that injected neurons were large neurons characteristic of the SRV. Trigeminal tractotomy just rostral to the obex did not eliminate responses of SRV units to trigeminal inputs. Neurons relaying trigeminal inputs to SRV neurons were electrophysiologically identified in the nucleus reticularis parvocellularis which is ventromedially adjacent to the subnuclei oralis and interpolaris of the trigeminal spinal tract nucleus. These findings were supported by HRP injection into the SRV. Units having receptive fields similar to those of SRV neurons were found in lamina VII of the first cervical cord, suggesting that SRV neurons may be trigeminal lamina VII neurons.

Occurrence of hypercalcemia and leukocytosis with cachexia in a human squamous cell carcinoma of the maxilla in athymic nude mice: a novel experimental model of three concomitant paraneoplastic syndromes

Hypercalcemia and leukocytosis may occur in conjunction as paraneoplastic syndromes associated with malignant disease. Here we describe a human squamous cell carcinoma of the maxilla that was associated with hypercalcemia and leukocytosis, and also cachexia. The primary tumor was surgically removed and established in permanent cell culture. When either primary tumors or cultured tumor cells were inoculated into nude mice, the nude mice developed the same paraneoplastic syndromes as those which occurred in the patient from whom the tumor was originally derived. The plasma calcium was increased two and one-half-fold and the WBC count 30-fold, and the body weight was decreased by 45% in tumor-bearing animals. Each of these paraneoplastic syndromes was alleviated by surgical excision of the tumor, indicating that the paraneoplastic syndromes were due to a factor or factors produced by the primary tumor. The development of each of these paraneoplastic syndromes in nude mice correlated positively with the other two syndromes. We examined the organs of tumor-bearing mice and found striking histopathologic abnormalities in the bones, spleen, and liver, but no infiltration with tumor cells. The bones showed marked evidence of osteoclastic bone resorption. This model of a human tumor associated with the hypercalcemia-leukocytosis paraneoplastic syndrome, together with cachexia, should make it possible to determine the mechanisms responsible for these paraneoplastic syndromes and their relationship to each other.

The effect of furosemide on the endocochlear potential in ears with experimentally induced endolymphatic hydrops

The endocochlear potential (EP) was measured in 38 guinea pigs with experimentally induced endolymphatic hydrops at the 3rd, 6th, 12th and 24th postoperative weeks, and the effects of furosemide (FUR, 50 or 80 mg/kg) on the EP were examined. A time-related reduction of the EP from the normal value and increased susceptibility to FUR were disclosed in the hydropic animals. Furthermore, 24-week animals given 80 mg/kg FUR showed a significantly slower recovery rate of the EP than the other groups, indicating impairment of the strial function progressive with post-operative time. The negative component of the EP was considered to be unimpaired until at least 12 weeks after the surgery.

Three cases of oral squamous cancer associated with leukocytosis, hypercalcemia, or both

Three examples of malignant neoplasms primary to the oral cavity and associated with paraneoplastic syndromes are presented. The first case is a squamous cell carcinoma of the maxilla associated with leukocytosis. The second case is a mandibular squamous cell carcinoma associated with hypercalcemia in the absence of bony metastases. The third case is a squamous cancer of the tongue that metastasized to the lumbar vertebrae and right second rib and was associated with both hypercalcemia and leukocytosis. There was no evidence of acute infection or leukemia that could be expected to account for leukocytosis. Hypercalcemia in the second case was defined as humoral hypercalcemia of malignancy by biochemical and clinical evaluations. To our knowledge, this is the first definitive report of a carcinoma primary to the oral cavity associated with humoral hypercalcemia of malignancy. In each case, the severity of hypercalcemia, leukocytosis, or both very closely correlated with tumor growth. Surgical excision of the tumors or regression of tumor mass due to aggressive anticancer drug administration resulted in decreases in leukocyte number, serum calcium level, or both. In contrast, recurrence or regrowth of tumors induced further development of hypercalcemia, leukocytosis, or both. It is therefore likely that humoral factors released by these oral carcinomas are responsible for the hypercalcemia, leukocytosis, or both.