Postural sway frequency analysis in workers exposed to n-hexane, xylene, and toluene: assessment of subclinical cerebellar dysfunction

To clarify the effects of organic solvents on the postural balance system, 29 male sandal, shoe, and leather factory workers exposed to n-hexane, xylene, and toluene (solvent workers) were examined by computerized static posturography with sway frequency analysis. Concentrations of metabolites of solvents in urine samples taken from the workers in the morning before work ranged from 0.41 to 3.06 (mean, 1.20) mg/g creatinine (Cn) for 2,5-hexanedione, from 0.10 to 0.43 (mean, 0.19) g/g Cn for methylhippuric acid, and from 0.05 to 2.53 (mean, 0.37) g/g Cn for hippuric acid; estimated concentrations of n-hexane in workplace air ranged from 13 to 100 (mean, 40) ppm. Control subjects were 22 healthy males without exposure to solvents. With eyes open, postural sway with a frequency of 2-4 Hz in solvent workers was significantly larger than that in controls in the anteroposterior direction. With eyes closed, sway with a frequency of 0-1 Hz was significantly larger in solvent workers in the mediolateral and anteroposterior directions. Results of multiple regression analysis showed that with eyes open the 1- to 2-Hz and 2- to 4-Hz sways were related positively to 2,5-hexanedione and inversely with methylhippuric acid. The pattern of changes suggests that the vestibulocerebellar and spinocerebellar afferent systems are asymptomatically affected by n-hexane; the effect of n-hexane on the vestibulocerebellar system is possibly inhibited by xylene.

A young man with acute renal failure and severe loin pain

The first case of exercise-induced acute renal failure (EIARF) is reported measuring the blood flow and arterial resistance in the kidney by pulsed Doppler ultrasound. A 20-year-old Japanese male suffered from severe loin pain and non-oliguric acute renal failure after strenuous exercise. Serum myoglobin and creatine phosphokinase were normal and urinary myoglobin was not detectable. The Doppler pattern in several segmental arteries showed a slow end-diastolic velocity (EV) and a high resistance index (RI), indicating increased renal vascular resistance, which suggested severe renal vasoconstriction. Three days later, the EV had apparently increased and the RI normalized in accordance with improvement of renal function. The ultrasound Doppler technique is useful for the detection of a decrease in arterial blood flow on real time and for the diagnosis of EIARF.

Fluorescent diagnosis of experimental gastric cancer using a tumor-localizing photosensitizer

To clarify the usefulness of fluorescent diagnosis for gastric cancer, we assessed the sensitivity and specificity of the tumor-localizing photochlorine photosensitizer ATX-S10 in combination with a new fluorescence diagnostic system. Into the submucosa of the stomachs of five rabbits, VX-2 tumor cells originating from squamous cell carcinoma were injected. After 3 weeks, three rabbits (Group I) were sacrificed 3 h after intravenous injection of ATX-S10 at a dose of 20 mg/kg, and their stomachs were observed by the Hg-lamp-induced fluorescence diagnostic system. The other two rabbits (Group II) were also sacrificed without injection of ATX-S10 and observed by the same method. In all cases in Groups I and II, gastric cancers that were invaded from the submucosa to the serosa were recognized histologically. The concentration of ATX-S10 examined by high-performance liquid chromatography (HPLC) in the gastric cancer was significantly higher than in the normal stomach. Fluorescent spectroscopy could detect 630 nm fluorescence selectively, consistent with the cancerous tissue of Group I. Moreover, fluorescent images were detected in only the exposed area of cancerous tissue and were undetected in the surrounding normal mucosa. Conversely, no fluorescent images could be detected in the stomachs of Group II. It is suggested that a fluorescence diagnostic system using ATX-S10 may become useful for the diagnosis of the existence or extension of carcinoma of the gastrointestinal tract.

Anti-atherogenicity in women does not prevent restenosis after balloon angioplasty

To test the hypothesis that anti-atherogenicity in women exerts beneficial effects to prevent restenosis formation after coronary angioplasty, we studied 493 men (988 lesions) and 81 women (159 lesions), aged 40-60 years, who had undergone successful balloon angioplasty and had follow-up angiography, 4.9 +/- 4.1 months later. We compared the extent of restenosis between men and women, and between pre- and post-menopausal women, which was assessed by a categorical definition of restenosis (more than 50% diameter stenosis at follow-up) and by percent diameter measured immediately after angioplasty and at follow-up. Hypertension was more frequent in women and a significantly lower percentage of women smoked. In women, the levels of total cholesterol and low-density lipoprotein cholesterol were higher. The location of dilated lesions, frequency of angioplasty for lesions with chronic total occlusion, and frequency of emergency angioplasty in patients with unstable angina or acute myocardial infarction were similar in men and women. Restenosis formation, estimated by the categorical definition or percent diameter, did not differ between men and women, or between pre- and post-menopausal women. Menopausal status or sex was not an independent predictor of restenosis by multivariate analysis. Thus, the benefit of anti-atherogenicity in women does not play an important role in preventing restenosis after coronary angioplasty.

Neurophysiological methods in occupational and environmental health: methodology and recent findings

Neurophysiological measurement, a promising technique for assessment of the subclinical effects of occupational and environmental factors, is rapidly progressing following development of computer technology. The methods include measurement of evoked and event-related potentials, nerve conduction velocity, distribution of nerve conduction velocities, electrocardiographic R-R interval variability, and computerized static posturography. This paper provides an overview of these methods, except for evoked and event-related potentials, which have been reviewed previously by the authors, to evaluate the effects of occupational and environmental factors on the peripheral, autonomic, and cerebellar nervous systems. The available data indicate that these methods are sensitive, reliable, and easily applied in a field study. When conducting these measurements, controlling for confounding factors such as age, sex, height, skin temperature, alcohol ingestion, and neurologic diseases is necessary.

[Evaluation of nutritional status of patients on continuous ambulatory peritoneal dialysis (CAPD) by dual photon energy X-ray absorptiometry (DEXA)]

Malnutrition is a serious complication in patients on long-term CAPD treatment. Accordingly, quantitative evaluation of nutritional status is a critical issue. This study aimed to assess nutritional status by dual photon energy x-ray absorptiometry (DEXA) in CAPD patients. Total lean body mass (D-TBM), right arm lean mass (D-RAM) and body fat percent (D-% FAT) measured by DEXA were compared with mid-arm muscle circumference (MAMC) and body fat percent (AP-% FAT) measured by anthropometrics (AP) in 51 CAPD patients. The subjects were stratified into groups by gender, age, duration on CAPD, and diabetes mellitus or non-diabetes. There was significant correlation between D-TBM, D-RAM and MAMC (r = 0.519, p = 0.001, r = 0.545, p = 0.001) or D-% FAT and AP-% FAT (r = 0.763, p = 0.0001). However, in the groups of females with over 50 years and over 48 months of dialysis duration, there was no correlation between D-TBM, D-RAM and MAMC. The DEXA method is useful in the quantitative evaluation of nutritional status of dialysis patients serially.

[Spinal anesthesia with 2% plain lidocaine for ultrasonically guided vaginal oocyte retrieval]

Spinal anesthesia with 3 ml of 2% plain lidocaine was administered to 10 women for ultrasonically guided vaginal oocyte retrieval. Spread of anesthesia was assessed by skin vasodilatation, change of skin texture, loss of goose flesh reflex, and loss of cold as well as pin-prick sensation, and we studied time to complete motor block, time to two-segment regression, time to full motor and sensory recovery, ambulation time, haemodynamic parameters, and postoperative complications. The highest sensory block assessed by pin-prick was up to Th 8.3 +/- 3.4 10 min following spinal anesthesia. All patients had complete motor block and this was achieved at 9.0 +/- 1.7 min. Times to two-segment regression, full motor and sensory recovery, and ambulation were 84.5 +/- 31.0, 147.5 +/- 24.7, 176.5 +/- 23.2, and 203.3 +/- 50.0 min, respectively. No serious side effects were observed during the operation and postoperatively. We concluded that 3 ml of 2% plain lidocaine provided adequate spinal anesthesia for ultrasonically guided vaginal oocyte retrieval.

Low prevalence of activated protein C resistance and coagulation factor V Arg506 to Gln mutation among Japanese patients with various forms of thrombosis, and normal individuals

Resistance to activated protein C (APC), recently reported to be the most prevalent inherited cause of thrombosis among Caucasians, is associated with a single point mutation in the coagulation factor V gene. We investigated the prevalence of APC resistance and the factor V gene mutation (R506Q) in 34 consecutive Japanese patients with venous thrombosis or pulmonary thromboembolism and 63 control subjects. Three of the 33 patients examined (9%) had an APC ratio below the 5th percentile of control values (2.27), but all were above 2.0. The factor V mutation (R506Q) was not detected in the 29 patients studied, including the 3 patients whose APC ratios were below 2.27, or in 53 controls. In a tissue factor-based factor V assay to detect APC resistance recently described by Le et al. (Blood 1995;85:1704-1711), all patients studied were found to be normal including the three with a low APC ratio. We conclude that APC resistance and factor V gene mutation are less prevalent in Japan than in several European countries.

[Effectiveness of the radioactive strontium (89Sr) chloride agent, SMS.2P for pain palliation in patients with metastatic bone tumor in phase III multicenter clinical trial]

The phase III clinical trial of strontium-89 chloride agent (SMS.2P) was performed in 90 patients with painful bone metastases secondary to prostate (53), breast (18) and other types of cancer (19). Some patients experienced a transient increase in pain or nausea and vomiting. However both symptoms subsided and serious side effects were not observed in any of the patients. As reported, we confirmed some abnormal changes in peripheral blood picture. A decrease in the number of white blood cells and platelets was considered to be partly a result of bone marrow suppression due to 89Sr irradiation. Pain was substantially improved after 89Sr therapy in 58% of the patients and there was some alleviation in 12%. The release from pain was accompanied by an improved quality of life for these patients including sleep patterns and morbidity. Some patients were able to resume their former life styles. Most of the improved patients experienced pain relief from days to one week following 89Sr therapy and in half cases, this remained effective for 2 or 3 months. There were even cases in which the pain relief continued over an observation period of time of clinical study.

Oestrogen producing adrenocortical adenoma: clinical, biochemical and immunohistochemical studies

Oestrogen producing adrenocortical tumours are extremely rare. We report a 65-year-old woman who presented with abnormal vaginal bleeding, with no significant abnormalities in her uterus or ovaries, who was found to have a right adrenal mass by radiological examination. Excessive secretion of oestrogens from the tumour was demonstrated by adrenal venous sampling. Basal levels of corticosteroids were within normal limits. Adrenalectomy was performed and pathological examination revealed an adrenocortical adenoma measuring 5.5 cm in its greatest dimension, in which both clear and compact tumour cells were observed. Oestrogen levels normalized following the removal of the adrenal mass. Tissue concentrations of oestrone and oestradiol in the tumour were 6.9 (69.5 pmol/g wet tissue weight) and 34.6 (93.6 pmol/g wet tissue weight)-fold greater respectively than those of adjacent non-neoplastic adrenal cortex. Aromatase activity in the tumour tissue determined by the 3H-water method was 118.6 pmol/h/mg protein, equivalent to that of a full-term human placenta. Immunohistochemical analysis of aromatase demonstrated immunoreactivity in the tumour cells, especially in compact cells, but not in adjacent non-neoplastic adrenal cells. This is the first reported case of an oestrogen producing adrenocortical adenoma in which aromatase in the tumour cells was documented.

Mechanism of induction of prostaglandin E2 production by endothelin 1 in cultured rat mesangial cells

The phospholipase A2 inhibitors mepacrine, ONO-RS-082, and AACOCF3 completely inhibited prostaglandin E2 production induced by endothelin 1 in cultured rat mesangial cells, suggesting that phospholipase A2 is a critical enzyme in this process. TMB-8, an inhibitor of calcium mobilization from intracellular stores, abolished its production, while neither nicardipine nor chelation of extracellular calcium by EGTA did. The protein kinase C inhibitors, H-7 and staurosporine, and downregulation of protein kinase C could not inhibit prostaglandin E2 production, while W-7, a calmodulin inhibitor, abolished it. Pertussis toxin never influenced its production. Thus, endothelin 1 evokes prostaglandin E2 production in mesangial cells mainly through the activation of phospholipase A2, dependent on intracellular calcium and calmodulin and independent of extracellular calcium, protein kinase C, and pertussis toxin sensitive guanosine 5'-triphosphate binding proteins.

Distribution of glucocorticoid receptor immunoreactivity and mRNA in the rat brain: an immunohistochemical and in situ hybridization study

The localization of glucocorticoid receptor (GR) immunoreactivity and mRNA in the adult rat brain was examined by light microscopic and electron microscopic immunohistochemistries, and in situ hybridization. For the purpose of detailed investigation of the distribution and comparison of GR immunoreactivities and mRNAs, specific polyclonal antibodies against a part of the transcription modulation (TR) domain of rat GR were used in the immunohistochemistry, whereas fluorescein-labeled RNA probes, complementary to the TR domain in the GR cDNA were used in the in situ hybridization. In the rat brain, GR immunoreactivity was predominantly localized in the cell nucleus, and the expression of GR mRNA was detected in the cytoplasm. GR-immunoreactive and GR mRNA-containing cells were widely distributed from the olfactory bulb of the forebrain to the gracile-cuneate nuclei of the medulla oblongata. The highest densities of GR-immunoreactive and mRNA-containing cells were observed in the subfields of cerebral cortex, olfactory cortex, hippocampal formation, amygdala, septal region, dorsal thalamus, hypothalamus, trapezoid body, cerebellar cortex, locus coeruleus and dorsal nucleus raphe. The distributional pattern of GR immunoreactivity in many regions was well-correlated with that of GR mRNA, but in the CA3 and CA4 pyramidal layers of the hippocampus, different localization was noted. The present study provides the groundwork for elucidating the role of GRs in brain function.

Inhaled nitric oxide improved the outcome of severe right ventricular failure caused by lipopolysaccharide administration

OBJECTIVE

To evaluate the efficacy of nitric oxide (NO) inhalation against endotoxin-induced lung injury.

DESIGN

Randomized prospective short-term study.

SETTING

University school of Medicine Laboratory.

INTERVENTIONS

Animal experiment (using 16 Japanese white rabbits). The animals inhaled NO at a concentration of 10 ppm.

MEASUREMENTS AND RESULTS

The rabbits were randomly divided into the NO inhaling group (n = 7) and the control group (n = 9). Both groups received continuous infusion of 1200 mcg lipopolysaccharide (LPS) and the NO group inhaled 10 ppm NO during the LPS administration. In the control group, severe right ventricular (RV) failure was observed at 30-90 min of LPS infusion, and 4 of 9 animals died within 90 min of LPS infusion. In the NO group, none of the animals died and the early phase hemodynamic deterioration was milder than in the control group. But pulmonary gas exchange was not significantly different between the two groups throughout the study. At the end of the study there were no significant differences in any parameters of the surviving animals between the two groups.

CONCLUSION

Although an improvement of pulmonary gas exchange was not demonstrated, NO inhalation (10 ppm) improved the outcome of severe RV failure caused by LPS infusion.

[Diagnosis of pleural dissemination lung cancer by thin-section CT--a prospective study]

In this prospective study, thin-section CT was used to diagnose pleural dissemination in patients with pulmonary adenocarcinomas in which the primary lesion was found to be adjacent to the pleural surface by conventional CT. The subjects were 32 patients (25) who had undergone resection and 7 who had not with pulmonary adenocarcinoma without pleural effusion from among the 136 patients with pulmonary adenocarcinoma examined at our institution over 3 years. Thin-section CT images of three regions were obtained, and these included the pleural surface adjacent to the lesion, the minor fissure, and the diaphragmatic dome. Histopathological examination revealed pleural dissemination in 12 patients (5 who had undergone resection and who had not), in 2 of whom a diagnosis could not be made preoperatively. Pleural dissemination was diagnosed by CT in 12 patients; there were 2 false positives. In 6 patients who did not undergo resection, cancerous cells were found in fluid obtained by percutaneous pleural lavage, and mediastinal lymph node metastases or distant metastases were also detected. The diagnostic rate of CT was as follows interlobar space. 100% (7/7); mediastinum, 75% (3/4); diaphragm, 71% (5/7); and chest wall, 57% (4/7). In the patients who underwent resection, sensitivity was 100% for the interlobar space, but it was 0% to 33% for other pleural surfaces.

Rat whole-limb viability after cold immersion using University of Wisconsin and Euro-Collins solutions

The purpose of this study was to compare University of Wisconsin (UW) solution with Euro-Collins (EC) solution in their cold preservation effects on rat limbs. Thirty-six Lewis rat limbs were preserved in EC solution (n=18) or UW solution (n=18) at 4 degrees C for 72 hr, and grafted orthotopically to a syngeneic rat using microsurgical techniques. The surgeon was blinded to the solution used. We evaluated the vascular patency rate and death rate of both groups at day 7 after surgery and performed histological evaluations of bone, muscle, growth plate, and articular cartilage for each specimen of successful grafts in both groups. The vascular patency rates of the EC and UW groups were 27.7% (5/18) and 11% (2/18), respectively, and showed no significant difference. The death rates of the EC and UW groups were 50% (9/18) and 60% (10/18), which were not significantly different. There were no clear differences in histological viability between both groups, in all tissues exclusive of bone marrow and muscle tissue. Our results showed that in comparing EC and UW solutions, one was not significantly superior to the other as a cold immersion storage medium after a 72 hr ischemia-induced reperfusion injury.

Cloning, expression and characterization of plasma platelet-activating factor-acetylhydrolase from guinea pig

In a previous study, we purified PAF-acetylhydrolase, which converts PAF to an inactive metabolite, lysoPAF, from peritoneal fluid of guinea pigs subjected to experimental endotoxin shock and found that this purified enzyme had similar biochemical properties to the plasma enzyme [Karasawa, K., Yato, M., Setaka, M., and Nojima, S. (1994) J. Biochem. 116, 374-379]. In this study, we isolated a homogeneous enzyme preparation from guinea pig plasma using a similar procedure. The molecular mass of this purified enzyme, as determined by SDS-PAGE was 58-63 kDa, larger than that (43 kDa) of the human enzyme. To elucidate the molecular structure of this enzyme and clarify its relationships with PAF-acetylhydrolases of other species, we isolated and sequenced a cDNA encoding this enzyme. Its cDNA contains an open reading frame encoding 436 amino acids and its predicted molecular mass (49 kDa) is lower than that of the native enzyme, suggesting that guinea pig plasma PAF-acetylhydrolase, unlike the human enzyme, is modified post-translationally, perhaps by glycosylation.

Open knee dislocation associated with vascular injury successfully salvaged by primary arthrodesis in an elderly patient: a case report

Treatment by primary arthrodesis of the knee joint after temporary intraluminal shunt placement in a 70-year-old man with open knee dislocation involving the popliteal vessels is reported. After temporary shunting, the definitive vascular reconstruction of both the popliteal artery and vein was established by end-to-end anastomoses because of the shortening effect of the arthrodesis. Two skin coverage procedures were performed on day 0 and day 18. The patient recovered activity to a level near his pretrauma status. Primary arthrodesis for open knee dislocation associated with vascular injury in an elderly patient may be an efficacious procedure, depending on the patient's age, occupation, and level of activity.