Sonotubometry with a tubal catheter as an index for the use of a ventilation tube in otitis media with effusion

Insertion of a ventilation tube is considered to be an effective treatment for otitis media with effusion (OME), although it may entail complications such as residual perforation and poor hearing after tube extrusion. In order to reduce problems associated with ventilation tubes, we examined the Eustachian tube function in 25 adults with OME by two methods. One was a sonotubometric measurement (sonotubometry) with both a tubal catheter and a nasal olive tip, and the other was an air-pressure equilization method (deflation test). Sixty percent of the ears showed poor tubal function in both types of sonotubometry. The number of negative cases in sonotubometry with a tubal catheter was higher in ears with a larger volume of effusion, and in ears with poor tubal function by deflation testing. Judging from the volume of effusion and results of the deflation tests, the prognosis could be fairly good in many positive cases. We conclude that sonotubometry with a tubal catheter is useful in the management of OME, especially in evaluating the efficacy of ventilation tubes.

Detection of a carcinogen, 2-amino-1-methyl-6-phenylimidazo [4,5-b]pyridine, in airborne particles and diesel-exhaust particles

A carcinogen, 2-amino-1-methyl-6-phenylimidazo [4,5-b]-pyridine (PhIP), has been measured in airborne particles, diesel-exhaust particles, and incineration ash from garbage-burning plants. PhIP was found in all kinds of samples. In the light of the present results, together with the previous findings that PhIP was present in cooked foods and cigarette smoke, PhIP is likely to be an ubiquitous environmental pollutant. These observations also suggest that PhIP may be formed through the combustion process.

Effect of a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor on triglyceride kinetics in chronically streptozotocin-diabetic rats

The effect of simvastatin (MK-733, Banyu, Tokyo, Japan), a new inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase on triglyceride kinetics, was studied in chronically streptozocin-diabetic rats. Diabetic rats, in whom diabetes was induced by a single intravenous injection of streptozotocin (40 mg/kg body weight) 2 months before the experiment, had significantly higher plasma glucose, triglyceride, and cholesterol levels compared with nondiabetic control rats, but triglyceride secretion rate was not increased. Both triglyceride secretion rate and plasma triglyceride level were significantly suppressed under nonfasting conditions in diabetic rats fed a (0.1%) simvastatin-containing diet for 10 days. After an overnight fast, their triglyceride secretion rate was not suppressed by this diet. However, their plasma triglyceride level was significantly (50%) suppressed, suggesting improved triglyceride removal from the circulation. In diabetic rats, the newly secreted triglyceride-rich lipoprotein particles were significantly cholesterol-enriched, but simvastatin had no effect on their lipid composition. These results suggest that the hypertriglyceridemia seen in chronically diabetic rats is mainly due to a triglyceride-removal defect, and that simvastatin reduces plasma triglyceride levels in these rats both by stimulating triglyceride removal and by reducing its entry into the circulation.

Inhibitory effects of azelastine hydrochloride on Ca2+ influx, actin polymerization and release of eosinophil cationic protein of an eosinophilic leukaemia cell line EoL-1

The inhibitory effects of azelastine hydrochloride on PAF-induced and fMLP-induced Ca2+ influx, actin polymerization and calcium ionophore A23187-induced and aggregated IgG-induced release of eosinophil cationic protein (ECP) of an eosinophilic leukaemia cell line, EoL-1, were examined. EoL-1 cells cultured with 0.2 mM dibutyryladenosine-cyclic monophosphate for 48 hours showed an increase in intracellular free Ca2+ concentration ([Ca2+]i) and actin polymerization when stimulated by PAF and fMLP. Azelastine hydrochloride inhibited PAF-induced and fMLP-induced Ca2+ influx ([Ca2+]i) in a dose-dependent manner with an IC50 of 1 x 10(-8) M and 1 x 10(-7) M, respectively. It also inhibited PAF-induced and fMLP-induced actin polymerization in a dose-dependent manner up to 40% and 30%, respectively. EoL-1 cells were differentiated to contain ECP in their eosinophilic granules when cultured for 9 days with supernatants of a human adult T cell leukaemia cell line, HIL-3 (HIL-3 sup). Calcium ionophore A23187 and aggregated IgG induced the secretion of ECP by EoL-1 cells. Azelastine hydrochloride inhibited the secretion of ECP in a dose-dependent manner. These inhibitory effects were seen even at therapeutic concentrations of 10(-8) M to 10(-9) M. These results indicate that the therapeutic effects of azelastine hydrochloride as an anti-allergic agent may include inhibition of the accumulation of eosinophils into the locus of allergic inflammation and of the release of cytotoxic granules from eosinophils.

[Relationship between lymphocyte subsets of the peripheral blood and noise induced hearing loss]

Biochemical examination and two-color flow cytometric analysis of lymphocyte subsets of the peripheral blood were carried out in 107 healthy males working in high noise environments. The level of hearing disorder was compared with these results. By audiometry at six frequency levels, 51 of the 107 healthy males showed hearing loss. Their mean value of hearing ability was 30 dB and/or above. Among the peripheral lymphocyte subsets, helper T cells of CD4+CD45R- were significantly increased and the CD4/CD8 ratio tended to be elevated. CD20 that indicate B cells were reduced. These results suggested a relationship between susceptibility to acoustic trauma and cell-mediated immunity.

[Lomefloxacin concentration in human prostatic tissue following 3-day administration]

The penetration of Lomefloxacin (LFLX) into the prostatic tissue and the serum were examined. Forty four patients with benign prostatic hypertrophy treated with transurethral resection of the prostate (TUR-P) were entered in this study. LFLX was administered orally in a dose of 200 mg three times daily for three days preoperatively. The blood samples were taken simultaneously at the time of the tissue sampling. The patients were divided into groups 1 and 2. In group 1 (seventeen patients), the tissue sampling was done about 17 hours after the final drug administration. The mean concentration of LFLX was 3.31 +/- 1.16 micrograms/g in the prostatic tissue and 1.70 +/- 0.56 micrograms/ml in the serum. In group 2 (twenty seven patients), tissue sampling was done 5.5 hours after the final drug administration. The mean concentration of LFLX was 5.70 +/- 2.28 micrograms/g in the prostatic tissue and 2.93 +/- 1.14 micrograms/ml in the serum.

Surgical treatment of esophageal carcinoma in patients eighty years of age and older

Before 1979, no patient 80 years of age or older had been operated on at our institution for esophageal cancer, while in the middle period (1980-1984), three patients were operated on, and postoperative pulmonary complications and operative death occurred in 66.7 and 33.3%, respectively. However, in the recent period (1985-1990), there was no postoperative morbidity or mortality in the five cases over age 80. On the other hand, there were 12 patients over age 80 who did not undergo operation, of whom all died of cancer. In the eight operated patients over age 80, two cases are still alive 17 and 34 months after operation. According to the above findings, when the patient's general condition is evaluated to be sufficient to tolerate the operation and the cancer is judged to be resectable, esophageal resection is thought to be indicative in all patients over eighty.

Loxoprofen--another NSAID associated with acute asthmatic death

Loxoprofen sodium (sodium 2[4-(2-oxocyclopentylmethyl) phenyl] dehydrate; CAS #68767-14-6) is a nonsteroidal, inflammatory drug marketed only in Japan. A case report describes its association with an acute asthmatic death with features resembling those evoked by similar drugs. The analytic methodology is reported. The blood levels of loxoprofen were in the therapeutic range. The tissue concentrations are reported.

Motion sickness induced by sinusoidal linear acceleration in rats

The characteristics of linear acceleration to cause motion sickness of rats were examined using pica as a behavioral index of motion sickness. A vestibular sled was used to generate sinusoidal linear acceleration. At 0.4 Hz and with a peak acceleration of 0.15 G, the effectiveness of linear acceleration in inducing motion sickness was X-axis > Y-axis > Z-axis. At 0.4 Hz and along the X-axis, rats suffered from more severe motion sickness with a high peak G load (0.15 G) than with a low one (0.08 G). Along the X-axis and with a peak acceleration of 0.15 G, the severity of motion sickness was not related to frequency (0.4, 0.6 Hz).

Studies on asphyxia: morphological research for the aid of diagnosis of asphyxia using light and electron microscopy and immunohistochemical methods

The lattice-form structure and/or tubular myelin can be found in the debris-like structure which is the pinkish substance in the alveolar space in the Hematoxylin & Eosin stained sections. These findings were obtained by using rats in the air containing oxygen of 5% or mixing and/or contaminating each of methane, carbon dioxide, carbon monoxide and freon gases. The immunohistochemical detection using the monoclonal mouse antibody against human pulmonary surfactant (PS) apoprotein is of highly useful. The positive reaction products observed in the alveolar space indicate the localization of the tubular myelin. The data suggest that the PS appears when the inhaled air contains oxygen in low concentration. The immunohistochemical method using the antibody against human PS apoprotein is worth applying for the diagnosis of oxygen deficiency including the respiratory distress syndrome (RDS) of the new born. We conclude that the appearance of the positive reaction products suggests that, at least, the air did not come in contact with the surface of alveoli, which leads us to the diagnosis of death was from oxygen deficiency, even if we are at the stage when the mode of death is undetermined.

Hyperthermo-chemo-radiotherapy as a definitive treatment for patients with early esophageal carcinoma

Ten patients with early stage esophageal carcinoma were treated with hyperthermo-chemo-radiotherapy (HCR) without surgery. The reasons for the inoperability of these patients included medically inoperable unresectable cancers, advanced age, and/or refusal to undergo surgery. The diagnosis of early esophageal carcinoma was determined by esophagograms, endoscopy, and ultrasonography. Squamous cell carcinoma was histopathologically confirmed in each case. Each patient underwent four to nine sessions of hyperthermic treatment combined with external irradiation and chemotherapy using bleomycin; eight of these patients received additional radiation, and two terminated treatment after the HCR therapy. The tumors in all patients showed either a complete response (CR) or a partial response (PR) after HCR therapy; in two patients viable cancer cells remained, but later disappeared after additional radiation. Five patients experienced no local recurrence for 12 to 70 months and are now alive and doing well, three died of other medical conditions without any evidence of esophageal cancer, and two died of recurrent esophageal cancer 20 to 27 months after initial admission. All ten patients tolerated the HCR well without any systemic side effects. However, in two patients, esophageal erosion was recognized endoscopically. HCR therapy therefore deserves serious consideration when treating patients with small malignant lesions of the esophagus who, for various reasons, are unable to undergo surgery.

Vestibular, central and gastral triggering of emesis. A study on individual susceptibility in rats

Using kaolin intake as a behavioral index of emesis in rats, we examined the relationship between susceptibility to motion sickness and to emesis induced by apomorphine or copper sulfate. Rats showed a wide variation in susceptibility to motion sickness. Significant positive correlations were found between susceptibility to motion sickness and to emesis induced by intraperitoneal administration of apomorphine and by oral administration of copper sulfate. Motion, apomorphine and copper sulfate induce emesis through different receptors, so these findings suggest that the sensitivity of a common locus of emesis, presumably the emetic center in the brain stem, is one determinant of individual differences in susceptibility to motion sickness.

[A case report of aorto-pulmonary window associated with atrial septal defect]

The patient was a one-year-old boy, who underwent surgery with a diagnosis of atrial septal defect (ASD). During operation, aorto-pulmonary window (A-P window) which had not been detected by the preoperative examinations, was found. Therefore, the A-P window was divided prior to closing ASD. The patient is in good condition six months after the operation. The causes of the inaccurate preoperative diagnosis were discussed.

Influence of low dissolved oxygen concentration in body fluid on corrosion fatigue behaviors of implant metals

In their previous study, the authors carried out a fatigue test for AISI 316, 316L stainless steels and COP1 alloy in a living animal body and observed a remarkable deterioration in the fatigue durability of these metals. In that study, it was concluded that the reason the corrosion resistance of the metals was reduced in the living body was that the low concentration of dissolved oxygen gas in the body fluid (the partial pressure pO2; 28-78 mmHg) was insufficient to form the chromium oxide passivation film on the metal surface, and the base metal (iron) was released into the environmental fluid in ionic form. In this paper, with the concentration of dissolved oxygen gas in a physiological normal saline solution being set equivalent to that of living body fluid, fatigue tests on AISI 316 were made to simulate the stress corrosion behavior of the metal in the living body. As a result, remarkable deterioration of fatigue strength was observed in the low O2 concentrated normal saline solution, which was the same as that in the living animal body.

Distribution of 1,5-anhydro-D-glucitol in normal, diabetic, and perfused rat bodies

The concentration of 1,5-anhydro-D-glucitol (AG) was determined in various organs and tissues of normal rats and rats rendered diabetic with streptozocin, using an AG-assay method in which AG was extracted after acid hydrolysis of the whole tissues. The organs and tissues examined included skin, muscle, liver, and kidney. The plasma of control rats contained 3-12 micrograms/ml of AG. In these rats, all the organs examined also contained AG at concentrations not much lower than that in the corresponding plasma, except for adipose tissues and testis, which have relatively small water spaces; the latter two contained AG at relatively low concentrations. In contrast, both the plasma and various organs of the diabetic rats contained only trace amounts of AG. The whole body perfusion of control rats depleted AG from most of the organs, the exception being spleen, the circulation system of which is known to have a structure that is difficult wash by means of perfusion. These observations indicated that AG readily diffused into the inter- and intra-cellular water spaces from the circulation. Accordingly, the plasma membranes of the cells in these organs were suggested to be permeable to AG.

[The results and problems of reoperation for coronary artery disease]

In six hundred and six consecutive patients undergoing coronary artery bypass grafting (CABG) within the past 17 years (May 1974 to March 1991), repeated CABG were performed on 10 patients (1.65%). The main reasons for repeated CABG were graft failure (GF) in 8, progression of native disease (NP) in 5 and incomplete revascularization (IR) in 3 patients. The incidence of GF was high either within a half year or around 5 years after CABG. Although all patients survived from reoperation, four patients continued to have mild angina pectoris. When the recurrence of angina is noted after CABG, coronary arteriography and if necessary PTCA should be done as soon as possible. If a second surgery is inevitable, maximum utilization of arterial graft and accomplishment of complete revascularization are emphasized.

Determination of the resection line in early esophageal cancer using intraoperative endoscopic examination with Lugol staining

Determination of the resection line using intraoperative endoscopic examination with Lugol staining was performed when preoperative examinations such as an esophagogram could not be effectively carried out and the carcinoma was not palpable from the outer surface of the esophageal wall. During the past two years, we performed this technique on eight patients. The carcinoma was restricted within the epithelium in one, the mucosal layer in five, and the submucosal layer in two. Although intraepithelial carcinoma contiguous to the main lesion was seen in six and cancer multiplicity was evident in two, all of the resected stumps were free of any cancer tissue. There have been no cases of recurrence and a limited operation, such as distal esophagectomy, was able to be performed in six. Therefore, intraoperative endoscopic examination is useful for early esophageal cancer.

[A case of coronary artery bypass for bilateral coronary ostial stenosis in aortitis syndrome with occlusion of bilateral subclavian arteries]

A 52-year-old female with bilateral coronary ostial stenosis in aortitis syndrome underwent CABG. Vein grafts were used instead of arterial grafts, because of the occlusion of bilateral subclavian arteries. Proximal anastomosis of the grafts was performed after oval stomas larger than usual were created on the aortic wall to prevent late graft occlusion due to intimal proliferation of the aorta. On postoperative CAG, all grafts to RCA, LAD and Cx were patent. The patient left the hospital 3 weeks after surgery. We believe that CABG is preferable to the transaortic endarterectomy in the surgical treatment for coronary ostial stenosis associated with aortitis syndrome, because of the prevalence of technical difficulty and postoperative morbidity in the latter.

[Clinical evaluation of oral ofloxacin in 3-day therapy for transurethral resection of the prostate]

The effectiveness of oral administration of an antibacterial alone was compared with that of intravenous administration of an antibiotic in patients with benign prostatic hyperplasia undergoing transurethral resection of the prostate (TUR-P). In group A (23 patients), surgery was carried out by administering 200 mg of ofloxacin (OFLX) alone, during the day before surgery and in the morning of the day of surgery and three times a day from the morning after surgery for two days, making the total dose 1,800 mg, and total period of administration 3 days. In group B (22 patients), 1 g of Cefotetan (CTT) was intravenously infused twice a day for 3 days from the operative day, making the total dose 6 g. The patients in both groups were given no other antibacterials or antibiotics. The maximum body temperature was recorded for post-operative 2 weeks. Negativization of bacteria by bacterial culture in the urine and disappearance of the pyria, were followed up on an outpatient bases. The mean maximum body temperature up to post-operative week 2 was 37.1 +/- 0.3 degrees C and 37.0 +/- 0.3 degrees C in groups A and B, respectively. The mean number of days required until negativization of bacteria in the urine was 41.5 +/- 38.9 days and 43.3 +/- 24.9 days in groups A and B, respectively. The mean number of days required until disappearance of the pyuria was 76.5 +/- 23.0 days and 68.2 +/- 17.9 days in groups A and B, respectively. No significant differences were noted by Student's t-test between groups A and B.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary artery bypass utilizing vein grafts: why didn't we use an arterial graft?]

Internal thoracic artery (ITA) grafts for coronary artery bypass grafting (CABG) are superior to SVG in the long-term patency and survival. In spite of our effort to utilize ITA whenever possible, we still have some cases which have to receive only vein grafts. Among the consecutive 201 patients undergoing CABG in the past three years, 32 patients (16%) received only vein grafts. We compared these patients (SVG group) with those who received ITA grafts (ITA group). The SVG group consisted of all emergency cases and many cases with single and double vessel disease. In the SVG group, perioperative use of IABP was more frequent and operative mortality was higher, although the number of grafts was fewer (2.66 vs 3.61) and aortic cross clamping time was shorter in this group. Main reasons for selecting only vein grafts were emergency surgery, inadvertent injury of ITA, inadequate ITA free flow etc. Technical refinement in the preparation of ITA is important to make possible wider application of arterial grafts for CABG.

Effect of probucol on recovery from streptozotocin diabetes in rats

The present study was conducted to see the effect of probucol on streptozotocin diabetes in rats. After 2 weeks of a 1% probucol diet, 35 or 50 mg/kg of streptozotocin were intravenously injected into male Wistar rats. All the rats became diabetic 2 days after treatment. Thereafter, in order to see the effect of probucol on spontaneous recovery from streptozotocin diabetes, 25 mg/kg of streptozotocin was injected into rats after two weeks of probucol diet and the diet was continued for additional two weeks. All the rats with a standard diet (group CS, n = 13) and 12 of 13 rats with probucol diet (group PS) became diabetic 2 days after streptozotocin injection. One rate from group PS did not develop diabetes. Two weeks after injection, only 4 of 13 rats in groups CS showed recovery, while 11 of 12 rats in group PS showed recovery from streptozotocin diabetes (p less than 0.05). The average blood glucose levels in group PS were significantly lower than group CS (10.5 +/- 4.6 vs 18.5 +/- 0.6 mM, p less than 0.05). In addition, the pancreatic insulin content of group PS was 8 times greater than that of group CS (0.75 +/- 0.24 vs 0.09 +/- 0.03 mmol/pancreas, p less than 0.01). Thus, the in vivo diabetogenic action of streptozotocin could not be reduced by pretreatment with probucol. However, recovery from streptozotocin diabetes was induced by subsequent treatment with probucol. The precise mechanisms for this phenomenon were not known; but the present findings suggest the protective effect of probucol on beta-cell damage induced by small dose of streptozotocin.