Clinical and electrocardiographic characteristics of responders and nonresponders to class IA antiarrhythmic drugs

A retrospective analysis of 44 patients was carried out to evaluate the efficacy of class IA antiarrhythmic drugs (disopyramide and/or procainamide), and of drugs of one or more other classes by means of 24-hour Holter recording. This study included only patients who exhibited 5000 or more ventricular premature complexes (VPCs) during a 24-hour pretrial baseline recording. The drugs that reduced the frequency of VPCs by at least 50% were considered effective. Eighteen patients (41%) responded to class IA drugs (responders) and 26 patients (59%) did not (nonresponders). There was a significant difference between the two groups in relation to the types of disease (p less than 0.01), but no significant difference with regard to other clinical and electrocardiographic characteristics. There was a significant discordance between trials of class IA drugs and class IC drugs (p less than 0.05). The efficacy of class IA drugs is very similar to that of class IB drugs, and only class IC drugs represent the highest efficacy in patients refractory to both class IA and class IB drugs. In conclusion, when ventricular arrhythmias do not respond to class IA or IB drugs, class IC drugs could be chosen as the next regimen.

Induction of antigen-specific unresponsiveness to pancreatic islet allografts by antilymphocyte serum

The mechanism (or mechanisms) underlying the indefinite survival of DBA/2 islet allografts in strongly histoincompatible (C57BL/6xA)F1 (B6AF1) mice, induced either by the combined use of Ficoll-prepared crude islets and treatment of recipients with antilymphocyte serum (ALS), or by the use of handpicked, purified islets in nonimmunosuppressed recipients, was examined. B6AF1 mice bearing DBA/2 crude islet allografts for more than 100 days following ALS treatment accepted secondary DBA/2 crude islet allografts, but acutely rejected third-party A.SW crude islet allografts. This antigen-specific unresponsiveness to islet allografts can be successfully transferred into syngeneic B6AF1 mice by spleen cells. However, the state of unresponsiveness to donor antigen observed in these animals appears to be relatively weak, since transplantation of DBA/2 skin allografts or injection of DBA/2 spleen cells (5 x 10(7] caused acute rejection of long-term-accepted islet allografts. In contrast, B6AF1 mice bearing DBA/2 purified islet allografts over 100 days without immunosuppression rejected the secondary DBA/2 crude islet allografts acutely. Transfer of spleen cells obtained from these animals to syngeneic B6AF1 mice failed to induce prolongation of DBA/2 crude islet allografts. Thus, the mechanism (or mechanisms) involved in the long-term acceptance of islet allografts induced by the use of ALS and crude islets appears to be different from that involved in the long-term acceptance of purified islet allografts. The possible roles played by ALS in the induction of specific unresponsiveness to islet allografts are discussed.

Immunohistochemical localization of pulmonary surfactant apoproteins in various lung tumors. Special reference to nonmucus producing lung adenocarcinomas

Eighty-nine primary lung carcinomas and 23 metastatic lung tumors were immunohistochemically studied for the expression of pulmonary surfactant apoproteins, by using monoclonal (PE-10) and polyclonal antibodies. Surfactant apoprotein was demonstrated in the cytoplasm and/or nuclear inclusion bodies of only primary lung adenocarcinomas (36 of 75 cases), not in any other histologic type of primary lung carcinoma or in metastatic lung tumors. In primary lung adenocarcinoma, although typical type II pneumocyte type adenocarcinoma was not included in the current series, the majority of surfactant apoprotein-positive single cell type tumors were of the Clara cell type, with a single bronchial surface epithelial cell type, according to the light microscopic subclassification of adenocarcinoma cells. The Clara cell type adenocarcinomas could at times be distinguished only with difficulty from adenocarcinoma of type II pneumocyte type. Normal and hyperplastic type II pneumocytes were of course positive for surfactant apoprotein in the cytoplasm. However, none of the positive cells could definitely be identified as Clara cells in non-neoplastic lungs. The findings obtained in this study indicate that surfactant apoprotein is a good marker to distinguish adenocarcinoma of the lung from other histologic types of lung cancer and from neoplasms metastatic to the lung, and that type II pneumocytes and Clara cells, non-neoplastic and neoplastic, are morphologically and functionally closely related and might belong to the same cell lineage.

Central versus peripheral effect of clonidine on hepatic venous plasma glucose concentrations in fasted rats

To evaluate whether clonidine exerts its action within the central nervous system or outside the central nervous system to induce hyperglycemia, we compared the effects of clonidine injected into the third cerebral ventricle or intravenously on hepatic venous plasma glucose concentrations in fasted rats. Clonidine administration produced a dose-dependent hyperglycemia in each case. At all tested doses (5, 50, and 100 nmol) the hyperglycemic responses to clonidine injected intravenously were not significantly different from those to clonidine injected into the third cerebral ventricle. Intraperitoneal pretreatment with yohimbine (50 nmol) or phentolamine (50 nmol), both alpha-adrenergic antagonists, reduced the hyperglycemic response to clonidine (100 nmol) given intravenously, but these antagonists preinjected into the third cerebral ventricle did not reduce the response. Moreover, no significant differences in venous plasma clonidine concentrations were observed when intravenous and third cerebral ventricle injections of clonidine (100 nmol) were compared. These results suggest that clonidine-induced hyperglycemia is mainly mediated by the peripheral mechanism rather than through the central mechanism. To gain an insight into the peripheral mechanism for the hyperglycemic action of clonidine, we measured the plasma immunoreactive glucagon and insulin concentrations after intravenous clonidine (100 nmol). We found that plasma immunoreactive glucagon concentrations significantly increased, whereas plasma immunoreactive insulin concentrations did not change significantly despite hyperglycemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Prolonged survival of hamster-to-rat liver xenografts using splenectomy and cyclosporine administration

The immunosuppressive effect of splenectomy, alone or in combination with cyclosporine (CsA), was examined in hamster-to-rat orthotopic liver xenografts. The mean survival time was 7.3 +/- 0.5 days in untreated controls, 7.6 +/- 0.8 days with 40 mg/kg/day CsA, 7.2 +/- 0.4 days with splenectomy alone, and 17.6 +/- 5.6 days with splenectomy combined with 30 mg/kg/day CsA (P less than 0.01). The longest survival time was 27 days in this group. Marked enlargement of the spleen and high lymphocytotoxic antibody titer were characteristic of the unmodified recipients and those treated with CsA alone. Splenectomy by itself decreased the antibody formation without improvement of graft survival. In animals treated with the combined regimen, the lymphocytotoxic antibody titer was significantly suppressed, and the PMN and round cell infiltration were greatly reduced. Therefore, a synergistic effect was postulated between cyclosporine and splenectomy in this liver xenograft system.

Correlation of regional insulin and glucagon content in canine pancreas and a possible interaction of A and B cells

Canine pancreases divided into 8 anatomical subportions were examined for their regional insulin and glucagon content. Insulin content in the pancreas was gradually increased in the left lobe to about twice as much as that in the uncinatus, while glucagon content was increased steeply in the left lobe to 16 times as much as that of the uncinatus. Although hormonal content differs according to the anatomical area, a statistically significant positive correlation of mean regional insulin and glucagon content was observed (r = 0.994, p less than 0.001). A constant ratio of these two hormones suggests the functional coupling of A and B cells within the islets or in a given pancreatic subportion.

[Serum beta 2-microglobulin in spinal cord injury patients--its efficacy as a screening test of renal function]

We evaluated the reliability of serum beta 2-microglobulin (beta 2-MG) in comparison with serum creatinine, blood urea nitrogen and creatinine clearance in 164 patients with spinal cord injury. The value of serum beta 2-MG demonstrated the highest correlation coefficient (r = -0.927) in relation to creatinine clearance. The beta 2-MG value reflected the severity of hydronephrosis on excretory urography, with very few false negative values. The value of beta 2-MG is concluded to be one of the best screening tests in evaluating renal function in spinal cord injury patients.

Elastic fibers in tunica propria of undescended and contralateral scrotal testes from cryptorchid patients

Elastic fibers in the tunica propria of the testes from cryptorchid patients and normal fertile adults were examined by light (Weigert resorcin-fuchsin stain) and electron microscopic techniques. In the testes from normal fertile adults, elastic fibers were proved to exist in the tunica propria by light and electron microscopy, and were located in the fibrous and cellular layers of the tunica propria. In the undescended testes from the cryptorchid patients, during prepubertal and pubertal periods, elastic fibers could not be visualized in the tunica propria, but were found after puberty. The positive Weigert reaction of the tunica propria in the undescended testes from postpubertal cryptorchid patients, however, was markedly weaker than that in normal control patients, suggesting diminution of elastic fibers. This diminution of elastic fibers in the undescended testes from postpubertal cryptorchid patients was also substantiated by electron microscopy. However, in the contralateral scrotal testes, elastic fibers appeared during puberty and were observed after puberty in the same manner as in normal testes. Thus, the present study suggested retarded appearance of elastic fibers in puberty and impaired development of those fibers after puberty, in the undescended testes of cryptorchid patients.

Effects of verapamil and sodium nitroprusside on acetylcholine-induced contraction of the rabbit detrusor muscle

Effects of extracellular and intracellular Ca2+ on acetylcholine-induced contraction of the bladder detrusor muscle were studied in vitro, utilizing two types of Ca2+ antagonists of different mechanisms of action; verapamil and sodium nitroprusside (NP). Acetylcholine (10(-8) to 10(-2) M) caused dose-dependent contractions of the detrusor muscle strips. Pretreatment of the strips with verapamil (10(-7), 10(-6) M) significantly inhibited the acetylcholine-induced contraction in a dose-dependent manner, whereas NP (10(-7) to 10(-5) M) failed so suppress the contraction. The contraction of the strips once elicited by acetylcholine (10(-6) M) could be completely relaxed by verapamil (10(-5) M) addition, but only incompletely by NP (10(-5), 10(-4) M). In Ca2+-free solution containing 0.01 mM EGTA, replenishment of Ca2+ (2.5 mM) to the medium caused contractions of the strips. Addition of acetylcholine (10(-6) M) to the medium enhanced the Ca2+-induced contraction, which was significantly inhibited by pretreatment with verapamil (10(-6) M), but not affected by NP (10(-6) M). In Ca2+-free medium containing 0.1 mM EGTA, acetylcholine caused a slight degree of tension increase of the strips in a dose-dependent fashion, at higher concentrations exceeding 10(-6) M. These results suggest that the detrusor muscle contraction induced by acetylcholine is mostly dependent of extracellular Ca2+ influx both in its initiation and maintenance. It is also supposed, however, that intracellular Ca2+ fractions will partly participate in the acetylcholine-induced contraction and possibly in its maintenance.

[A case report of malignant schwannoma originating from the bone]

While malignant schwannoma is encountered frequently as soft tissue sarcomas, it rarely is found to originate in the bone. We have had a case of malignant schwannoma originating from the tibia of a 47-year-old man. He died from uremia, that resulted from lung, spinal vertebral body, and lymph nodes metastases, despite surgical treatment and chemotherapy. In cases of rare bone tumors, the clinical diagnosis of tumoral manifestations originating in the bone is more important than the histopathological diagnosis.

A study of cryptorchidism. III: The histochemistry of complex carbohydrates in the testes of cryptorchid patients

The complex carbohydrates in the undescended and contralateral scrotal testes of patients with cryptorchidism, were examined by light microscopic histochemical methods, in comparison with those of normal testes. In the undescended testes, histochemical reactions for acidic and neutral complex carbohydrates were apparently weaker than in the normal testes, especially pronounced in the seminiferous tubular walls. In the germinal and supporting cells of the undescended testes, the amount of galactose residues in the complex carbohydrates decreased from the prepubertal to post-pubertal periods. Periodic acid-Schiff reaction also revealed a decrease in the glycogen content in the germinal and supporting cells of the undescended testes from pre-pubertal to post-pubertal periods.

Incontinence in female neurogenic bladders. Resolution by endoscopic bladder neck suspension

Five incontinent females with neurogenic bladder diseases underwent endoscopic vesical neck suspension (Stamey procedure). Four patients have become dry on clean intermittent catheterisation and one has shown improvement. Bladder capacity was increased to a reasonable size in all patients. There has been no upper tract deterioration during the follow-up period of 3 to 25 months. We believe that the Stamey procedure is useful in alleviating urinary incontinence in neurogenic bladders provided that the bladder is drained regularly by intermittent catheterisation and that low detrusor compliance or detrusor hyper-reflexia is adequately managed.

Reproducible high yield of rat islets by stationary in vitro digestion following pancreatic ductal or portal venous collagenase injection

Pancreatic distension with collagenase solution followed by stationary in vitro digestion yields large numbers of intact islets. We compared in rats two routes of collagenase injection, pancreatic ductal (PD) and portal venous (PV), for islet yield, in vitro insulin secretory capacities, and in vivo functional viability. The islet yield in the PD method (n = 11) was greater than that in the PV method (n = 8) (682 +/- 27 vs. 417 +/- 39 per pancreas, P less than 0.025). The insulin release from the PD islets in response to 16.7 mM glucose increased gradually following culture, 3.2 +/- 0.8 ng/10 islets/30 min (fresh) to 12.3 +/- 2.1 (24-hr culture). In contrast, insulin release from the PV islets increased during the first 6 hr of culture, but decreased after 24 hr in culture. Under electronmicroscopic examination, the PD islets revealed a well preserved structure with healthy endocrine cells, while the PV islets showed a dilated capillary network and distorted endocrine cell continuity. When 100 PD islets were transplanted into streptozotocin-induced diabetic B6AF1 mice (n = 8), all the recipient mice restored normoglycemia (less than 200 mg/dl) within 1-4 days following transplantation and maintained it until rejection. However, the recipient mice given 100 PV islets showed a significant delay in restoring normoglycemia, and 3 of 8 mice given 100 PV islets were still hyperglycemic on day 4 postgrafting. In summary, pancreatic ductal collagenase injection followed by stationary in vitro digestion reproducibly yields higher numbers of intact and viable islets when compared with portal venous collagenase injection, indicating the superiority of this method to portal venous injection.

[A case of malignant paraganglioma arising from the retroperitoneum]

We report the case of 38-year-old male with a malignant and functional paraganglioma arising from the retroperitoneum. He was admitted to our hospital with a pathological fracture of the right femur, A diagnosis of paraganglioma was made after taking a biopsy specimen and discovering a hypervascular retroperitoneal tumor. The level of catecholamine in his urine was greatly increased, accompanied with hypertension, rapid pulse and sweating. He was treated with chemotherapy, radiotherapy and surgical therapy. However, he died from pulmonary metastasis.

[Inhibitory effect of a calcium entry blocker (verapamil) on detrusor muscle contractility: feasibility of clinical application]

Effects of a Ca2+ entry blocker (verapamil) on the contractility of the bladder detrusor muscle of rabbits were investigated in vitro and in vivo. In experiments using smooth muscle strips from the bladder detrusor, isometric tension changes of the strips following drug addition were recorded. The contractions of the strips induced by acetylcholine (10(-8)-10(-2)M), prostaglandin E2, F2-alpha (3 X 10(-8)-3 X 10(-5)M) or electric stimulation were significantly inhibited dose-dependently by pretreatment of the strips with verapamil (10(-7), 10(-6)M). In in vitro experiments using whole bladder preparations, the spontaneous contractile activity and the contraction induced by acetylcholine (10(-6)M) were monitored. Both activities were inhibited in a time-dependent manner after the intravesical instillation of 7.5 mg verapamil. The amplitude of the spontaneous contraction and responses to acetylcholine, 90 minutes after the instillation, were reduced to 10% and 38% of the control levels (before the instillation), respectively. The detrusor contractility was still inhibited 2 hours after the removal of verapamil from the bladder. During in vivo experiments, changes in intravesical pressure and systemic arterial pressure were monitored. Sixty minutes after the intravesical instillation of 10 mg verapamil, the rise of the intravesical pressure following the pelvic nerve stimulation was inhibited to 18% of the control level, whereas the systemic arterial pressure was not affected. Verapamil is suggested to have potent inhibitory effects on the detrusor muscle contraction, and the intravesical instillation of verapamil to inhibit detrusor contractility without affecting the cardiovascular status.