[A case of docetaxel-resistant breast cancer responsive to paclitaxel therapy]

A 73-year-old woman underwent docetaxel therapy for lung metastasis from breast cancer after having received CAF therapy. Because of the progressive disease due to secondary resistance to docetaxel, the patient was given three courses of paclitaxel therapy (60 mg/m2, day 1, 8, 15 and 22, repeated every 6 weeks). The paclitaxel therapy brought about no adverse effects and a 51%-reduction in the size of the metastatic lung tumor (PR). Although the duration of the response to the paclitaxel therapy was limited to about one month due to progression of a brain metastasis, paclitaxel therapy may be effective against docetaxel-resistant breast cancer.

[Surgery for thoracic aortic aneurysms involving the distal arch through a left thoracotomy]

Surgical outcome for thoracic aortic aneurysms involving the distal arch via a left thoracotomy using retrograde cerebral perfusion combined with profound hypothermic circulatory arrest was reviewed. Twelve patients with a atherosclerotic aortic aneurysm between 1994 and 1997 were involved. A proximal aortic anastomosis was made by means of an open aortic technique. For the first four patients, oxygenated arterial blood from cardiopulmonary bypass was perfused retrogradely through a venous cannula positioned into the right atrium. In the last eight cases, venous blood provided by a low-flow perfusion of the lower half body via the femoral artery, which was still oxygen-saturated, was circulated passively in the brain in a retrograde fashion with the descending aorta clamped. Prosthetic replacement was done between the distal arch and the proximal descending aorta in 6 patients and from the distal arch to the entire descending thoracic aorta in 6 patients. The median duration of hypothermic circulatory arrest and continuous retrograde cerebral perfusion was 36 minutes and 33 minutes respectively. The overall outcome was satisfactory without early mortality--all patients survived, although an octogenarian died of respiratory failure 1 year postoperatively. Another octogenarian with a ruptured aneurysm developed delay of meaningful consciousness, and other two patients with a severely atherosclerotic aneurysm suffered permanent neurological dysfunction (stroke) presumably due to an embolic episode. The safe and simple combination of profound hypothermic circulatory arrest, retrograde cerebral perfusion, and open aortic anastomosis protects the brain adequately and produces satisfactory results in surgery for aortic aneurysms involving the distal arch through a left thoracotomy.

Preparation and characterization of biodegradable or enteric-coated microspheres containing the protease inhibitor camostat

We have produced biodegradable or enteric-coated microspheres containing camostat mesylate, a protease inhibitor, using a water-oil-water emulsion solvent evaporation method. The characteristics of the microspheres were determined. When polylactic acid, a biodegradable polymer, was used as a wall material, the optimized microsphere obtained showed a loading efficiency of almost 95% and had a mean diameter of 30 microm. This microsphere showed a sustained-release profile, with nearly 25% of drug being released at seven days in a dissolution test. When hypromellose acetate succinate (AS-HG type, with a high content of succinyl group) was used as an enteric wall material, optimized microspheres showed a loading efficiency of almost 80%. In this case, pH 3.0 citrate buffer was used as an internal aqueous phase, and citrate buffer containing 0.5% polyvinylalcohol was used as the external aqueous phase. These microspheres showed a rapid release profile in pH 6.8 buffer, whereas the release was extremely slow in pH 1.2 buffer. Hypromellose acetate succinate microspheres were also prepared containing 10% (w/w) N-benzoyl-dl-arg-4-nitroanilide as a model substrate for trypsin, with or without 5% (w/w) camostat. These microspheres were incubated in pH 6 or 7 buffer containing trypsin at 37 degrees C. When camostat was included in the microspheres, the substrate was protected from attack by trypsin, while in the absence of camostat, the released substrate was immediately attacked by trypsin to produce the degradation product N-benzoyl-dl-arginine.

The inducible nitric oxide synthase inhibitor ONO-1714 blunts dextran sulfate sodium colitis in mice

In mice with acute dextran sulfate sodium colitis, we examined the effect of inducible nitric oxide synthase inhibition by (1S,5S,6R,7R)-7chloro-3-amino-5methyl-2-azabicyclo[4.1.0]heptane hydrochloride (ONO-1714) on colonic biochemistry, injury, and inflammation. Colonic luminal nitrate and nitrite were measured by the Griess reaction; inducible nitric oxide synthase messenger RNA expression by reverse transcription-polymerase chain reaction; and nitrotyrosine by immunohistochemistry. Mice with colitis showed increases in nitrate and nitrite, inducible nitric oxide synthase messenger RNA, and numbers of cells staining for nitrotyrosine. Colonic inflammation was severe. ONO-1714 inhibited increases in nitrate and nitrite and numbers of nitrotyrosine-positive cells; injury and inflammation also were reduced. Dextran sulfate sodium-induced increases in thiobarbituric acid-reactive substances, a lipid peroxidation marker, were blunted by ONO-1714, which also inhibited increases in mucosal inflammatory cytokines. Nitric oxide produced by inducible nitric oxide synthase may contribute to colonic inflammation by nitrosation, oxidative damage, and enhanced inflammatory cytokines.

Aortic arch repairs through three different approaches

OBJECTIVES

The outcome of aortic arch repairs by means of three different approaches between 1990 and January 2000 was reviewed.

METHODS

In total 39 patients aged 71.5+/-6.2 years were operated on. The three different surgical approaches depended on the anatomical positions of the aneurysms and on their proximal or distal extension; a median approach was employed in 23 patients, whereas a left postero-lateral approach was used in eight patients. More recently, in eight cases a left antero-lateral approach was applied. All patients underwent open aortic anastomosis without any clamp on or around the aortic arch. During the procedure, the brain was protected by a combination of profound hypothermic circulatory arrest and several techniques of retrograde cerebral perfusion.

RESULTS

Permanent cerebral dysfunction occurred in four patients: two in the median approach and two in the left postero-lateral approach. There were two hospital deaths (5.3%) and six late deaths, all of which belonged either to the median group or to the postero-lateral group. The antero-lateral approach did not produce any cerebral dysfunction, early death, or late death.

CONCLUSIONS

The outcome of aortic arch repairs using profound hypothermic circulatory arrest and variable techniques of retrograde cerebral perfusion, by means of three different approaches, was satisfactory. Of the three approaches, the antero-lateral approach can be employed easily, whether aneurysms extend proximally or distally.

Second generation amplicor-HCV monitor assay: clinical features and predictors of the response to interferon

The aims of this study were to compare the amplicor-HCV monitor assay versions 1.0 and 2.0, and to investigate the clinical usefulness of this assay in patients with chronic hepatitis C. We retrospectively analyzed 154 patients, and 133 of these patients received interferon therapy. Sixty-nine patients were complete responders (CR), and 64 were non-responders. Serum HCV RNA levels of version 1.0 and version 2.0 and HCV genotypes were determined in all patients. There was a good correlation between versions 1.0 and 2.0 in both genotype 1b and 2a, 2b (r=0.907 and 0.726, respectively). In genotype 1b, the mean HCV RNA level obtained by version 1.0 was 384+/-547 kcopies/ml and that obtained by version 2.0 was 488+/-825 kI.U./ml. In genotype 2a/2b, the mean level obtained by version 1.0 was 170+/-369 kcopies/ml and that obtained by version 2.0 was 340+/-402 kI.U./ml. Discriminant analysis revealed that the discriminating points of IFN response were 168 kcopies/ml (genotype 1b, version 1.0), 106 kcopies/ml (genotype 2a and 2b, version 1.0), 102 kI.U./ml (genotype 1b, version 2.0), and 277 kI.U./ml (genotype 2a and 2b, version 2.0). When the patients were stratified according to the discriminating points, the CR rate below the discriminating points were 73.8 and 86.2% in versions 1.0 and 2.0, respectively, in genotype 1b, and the rates were 73.2 and 82.3% in genotype 2a/2b. In addition, receiver-operating characteristic analysis revealed that version 2.0 had significantly better discriminative ability in patients with genotype 1b. We conclude that the second version of the amplicor-HCV monitor assay measures HCV RNA levels with the same precision as version 1.0 and is more useful for the prediction of interferon response than version 1.0.

Preparation and characterization of acrylic hydrogels neutralized by basic amino acids

Basic amino acids were used as neutralizers in the gellation of Eudispert as an acrylic hydrogel. Arginine and lysine successfully neutralized Eudispert, as did sodium hydroxide, and formed hydrogels. A gentle rise of pH was observed as the dosage of the base increased when arginine and lysine were used, in contrast to the sharp rise of pH observed when sodium hydroxide was used. The rank of viscosity of the prepared hydrogels was as follows: lysine > arginine > NaOH. The release rate of model drugs (salicylic acid, theophylline, and bovine insulin) from the prepared hydrogels ranked as follows: NaOH>lysine>arginine, the sustained-release profile being observed with arginine. The rate of diffusion of the model drug from the hydrogel was inversely proportional to the molecular weight of the cationized neutralizer used. It is concluded that the strategy of neutralization of acidic polymers by basic amino acids has advantage with the respect to both the sustained-release characteristics of the gel and the biocompatibility of the basic amino acids themselves.

Quantitative evaluation of the bitterness of commercial medicines using a taste sensor

The bitterness of 11 commercial medicines was evaluated both by a multichannel taste sensor and in human gustatory sensation tests with 15 volunteers. For basic drugs with amino groups in the molecule, such as quinine, there was a comparatively strong relative response electric potential (mV) of channels 1 or 2, those containing negatively charged membranes and the bitterness determined by human gustatory sensation tests. The suppression of the bitterness of quinine by sucrose and aspartame could be quantified using the artificial taste sensor and the results concurred with those from gustatory sensation tests. The usefulness of the sensor was thus confirmed for this type of compound. Anionic drugs, such as diclofenac sodium or salicylic acid gave rise in a negative response electric potential in channels 5 or 6, those containing positively charged membrane, seemed to be useful information even though their tastes are being sour rather than bitter. For drugs with both an amino (cationic) group and carboxylic acid (anionic) group in the molecule, such as theophylline, caffeine, and metronidazole, the relative response electric potential (mV) of channels containing negatively charged membranes was not increased, even though bitterness was observed in human gustatory sensation tests. Therefore, a different design of membrane component is required for more general evaluation of the bitterness of various medicines.

Repeated procedure after radical surgery for tetralogy of Fallot

BACKGROUND

Although the immediate results of radical operation for tetralogy of Fallot are excellent, long-term follow-up has shown that the number of repeated procedures has increased in many institutions. We describe patients who underwent a second or third procedure after radical operation for tetralogy of Fallot.

METHODS

Between April 1981 and August 1996, we operated on 44 patients for the second time and on 4 for the third time after radical operation for tetralogy of Fallot. Indications for a second and third procedure included right ventricular outflow tract obstruction in 38 patients, infective endocarditis in 4, and isolated residual ventricular septal defect in 3.

RESULTS

One patient died after concomitant replacement of the pulmonary and tricuspid valves. Three patients who underwent sternotomy more than twice (before the second or third operation) underwent accidental cardiovascular trauma during this procedure (30%). Moreover, when patients underwent more than two sternotomy procedures before the repeated operation for tetralogy of Fallot, the total bypass time, interval between cessation of the cardiopulmonary pump to completion of the operation, amount of blood transfusion, and length of intensive care unit stay were significantly higher compared with those who underwent less than two sternotomy procedures (p < 0.05). Right ventricular outflow tract obstruction was the main indication for a second operation. After the second operation for right ventricular outflow tract obstruction in 35 patients, the preoperative right ventricle to left ventricle pressure ratio decreased significantly (from 0.75 +/- 0.13 to 0.51 +/- 0.12; p < 0.0001). However, the right ventricle to left ventricle pressure ratio did not significantly decrease in patients who underwent a third procedure to treat right ventricular outflow tract obstruction.

CONCLUSIONS

The surgical results of a second procedure after radical operation for tetralogy of Fallot were acceptable. However, the risk of accidental cardiovascular trauma during dissection was high among patients who underwent sternotomy more than twice before repeat operation.

[Long-term results of right ventricular outflow reconstruction with valved conduit]

Twenty-nine patients who underwent right ventricular outflow tract reconstruction using a valved conduit 37 times and survived surgery, were reviewed in this study. Hancock, Ionescu-Shiley, Carpentier-Edwards and Polystan was used for RVOTR. Freedom from reoperation rates of Hancock, Ionescu-Shiley and Carpentier-Edwardsat at five and ten years after surgery were 100%, 85.7%, 89.2% and 75%, 28.6%, 89.2%, respectively. The freedom from reoperation rates of Hancock and Carpentier-Edwards were significantly higher than that of Ionescu-Shiley. In conclusion, the freedom from reoperation rate at ten years was high for both Hancock and Carpentier-Edwards.

Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. II. Walking on an inclined plane

The experiments described in this report were designed to determine the contribution of vestibulospinal neurons (VSNs) in Deiters' nucleus and of reticulospinal neurons (RSNs) in the medullary reticular formation to the modifications of the walking pattern that are associated with locomotion on an inclined plane. Neuronal discharge patterns were recorded from 44 VSNs and 63 RSNs in cats trained to walk on a treadmill whose orientation was varied from +20 degrees (uphill) to -10 degrees (downhill), referred to as pitch tilt, and from 20 degrees roll tilt left to 20 degrees roll tilt right. During uphill locomotion, a majority of VSNs (25/44) and rhythmically active RSNs (24/39) showed an increase in peak discharge frequency, above that observed during locomotion on a level surface. VSNs, unlike some of the RSNs, exhibited no major deviations from the overall pattern of the activity recorded during level walking. The relative increase in discharge frequency of the RSNs (on average, 31.8%) was slightly more than twice that observed in the VSNs (on average, 14.4%), although the average absolute change in discharge frequency was similar (18.2 Hz in VSNs and 21.6 Hz in RSNs). Changes in discharge frequency during roll tilt were generally more modest and were more variable, than those observed during uphill locomotion as were the relative changes in the different limb muscle electromyograms that we recorded. In general, discharge frequency in VSNs was more frequently increased when the treadmill was rolled to the right (ear down contralateral to the recording site) than when it was rolled to the left. Most VSNs that showed significant linear relationships with treadmill orientation in the roll plane increased their activity during right roll and decreased activity during left roll. Discharge activity in phasically modulated RSNs was also modified by roll tilt of the treadmill. Modulation of activity in RSNs that discharged twice in each step cycle was frequently reciprocal in that one burst of activity would increase during left roll and the other during right roll. The overall results indicate that each system contributes to the changes in postural tone that are required to adapt the gait for modification on an inclined surface. The characteristics of the discharge activity of the VSNs suggest a role primarily in the overall control of the level of electromyographic activity, while the characteristics of the RSNs suggest an additional role in determining the relative level of different muscles, particularly when the pattern is asymmetric.

Instigation and control of treadmill locomotion in high decerebrate cats by stimulation of the hook bundle of Russell in the cerebellum

In high decerebrate cats, pulse train microstimulation of a restricted region of the midline cerebellar white matter produced a generalized increase in postural muscle tone in the neck, trunk, and limb extensor muscles, and air-stepping of all four legs on a stationary surface. On the moving belt of a treadmill, such stimulation produced well coordinated, fore- and hindlimb locomotion as evoked by stimulating the mesencephalic locomotor region (MLR). Microinjection of a neural tracer into the cerebellar locomotion-inducing site resulted in a bilateral retrograde labeling of cells limited to the fastigial nuclei simultaneously with anterograde labeling of fibers projecting bilaterally to the medial pontomedullary reticular formation (mPMRF) the vestibular complex and upper cervical segments. These results have led to our proposition that the effective cerebellar locomotor region (CLR) corresponds to the midline region of the hook bundle of Russell. Passing through this structure are crossed fastigioreticular and fastigiovestibular fibers, together with fastigiospinal fibers. Subsequently, we showed that CLR stimulation resulted in simultaneous short-latency synaptic activation of long-descending reticulospinal and vestibulospinal cells with high synaptic security. Clearly, the fastigial nucleus possesses potential capability to recruit and regulate posture- and locomotor-related subprograms which are distributed within the brainstem and spinal cord by the in-parallel activation of fastigiospinal, fastigioreticular, and fastigiovestibular pathways.

Vestibulospinal and reticulospinal neuronal activity during locomotion in the intact cat. I. Walking on a level surface

To examine the function of descending brain stem pathways in the control of locomotion, we have characterized the discharge patterns of identified vestibulo- and reticulospinal neurons (VSNs and RSNs, respectively) recorded from the lateral vestibular nucleus (LVN) and the medullary reticular formation (MRF), during treadmill walking. Data during locomotion were obtained for 44 VSNs and for 63 RSNs. The discharge frequency of most VSNs (42/44) was phasically modulated in phase with the locomotor rhythm and the averaged peak discharge frequency ranged from 41 to 165 Hz (mean = 92.8 Hz). We identified three classes of VSNs based on their discharge pattern. Type A, or double peak, VSNs (20/44 neurons, 46%) showed two peaks and two troughs of activity in each step cycle. One of the peaks was time-locked to the activity of extensor muscles in the ipsilateral hindlimb while the other occurred anti-phase to this period of activity. Type B, or single pause, neurons (13/44 neurons, 30%) were characterized by a tonic or irregular discharge that was interrupted by a single pronounced and brief period of decreased activity that occurred just before the onset of swing in the ipsilateral hindlimb; some type B VSNs also exhibited a brief pulse of activity just preceding this decrease. Type C, or single peak, neurons (9/44 neurons, 23%) exhibited a single period of increased activity that, in most cells, was time-locked to the burst of activity of either extensor or flexor muscles of a single limb. The population of RSNs that we recorded included neurons that showed phasic activity related to the activity of flexor or extensor muscles [electromyographically (EMG) related, 26/63, 41%], those that were phasically active but whose activity was not time-locked to the activity of any of the recorded muscles (13/63, 21%) and those that were completely unrelated to locomotion (24/63, 38%). Most of the EMG-related RSNs showed one (15/26) or two (11/26) clear phasic bursts of activity that were temporally related to either flexor or extensor muscles. The discharge pattern of double-burst RSNs covaried with ipsilateral and contralateral flexor muscles. Peak averaged discharge activity in these EMG-related RSNs ranged from 4 to 98 Hz (mean = 35.2 Hz). We discuss the possibility that most VSNs regulate the overall activity of extensor muscles in the four limbs while RSNs provide a more specific signal that has the flexibility to modulate the activity of groups of flexor and extensor muscles, in either a single or in multiple limbs.

The cat neostriatum: relative distribution of cholinergic neurons versus serotonergic fibers

The distribution of choline acetyltransferase (ChAT)-containing neurons and serotonin (5-HT)-containing nerve fibers in the cat neostriatum was investigated by use of immunohistochemical techniques. Both ChAT- and 5-HT-staining techniques were applied to alternate brain sections, thereby allowing a precise comparison of the distribution pattern of ChAT-immunopositive cells (ChAT cells) and 5-HT-immunopositive fibers (5-HT fibers). In the neostriatum, ChAT cells were strongly stained throughout their cell bodies and proximal (first-order) dendrites. The majority of them were multipolar cells with a soma diameter of 20-50 microm (long axis)x10-30 microm (short axis). In the caudate nucleus, ChAT cells were evenly and diffusely distributed except for the dorsolateral region of its rostral half, in which latter region they were distributed in loosely formed clusters. In the rostral portion of the putamen, the density of ChAT-cell distribution was like that in the medial region of the caudate nucleus. In contrast, this distribution was more dense in the caudomedial region of the putamen, adjacent to the globus pallidus. 5-HT fibers in the neostriatum were dark-stained, of quite fine diameter (<0.6 microm), and they contained small, round varicosities (diameter, usually 0.5-1.0 microm, but some >1.0 microm). Such 5-HT fibers were distributed abundantly throughout the caudate nucleus and putamen. In the rostrocaudal portion of the caudate nucleus, their density was high in its dorsal and ventral components, and low in the middle component. Throughout the putamen, 5-HT fibers were distributed homogeneously in the mediolateral and dorsoventral directions. In the caudal portion of the putamen adjacent to the globus pallidus, the 5-HT fibers had a higher density while maintaining their homogenous distribution pattern. In the two main divisions of the striatum, the so-called 'patch' (acetylcholinesterase (AChE)-poor) and 'matrix' (AChE-rich) compartments, there was a near-even distribution of 5-HT fibers and terminals. The above results suggest that the 5-HT-dominated, raphe-striatal pathway is optimally arranged for modulating the activity of both the intrinsic and the projection neurons of the neostriatum.

Mast cell tumor in the nasal cavity of a dog

An 11-year-old male Shetland sheepdog displayed epistaxis and nasal discharge from the left nasal foramen. Cytological examination of a smear sample obtained by rhinotomy revealed neoplastic mast cells in the nasal cavity, a definitive diagnostic sign of mast cell tumor. The case was treated by surgery combined with radiotherapy and chemotherapy. Eighteen days after the last treatment, marked enlargement of the mandibular lymph nodes and facial edema developed, and the dog was euthanized at the owner's request. At necropsy, metastatic proliferation of mast cells was confirmed in the lymph nodes and liver, but no neoplastic mast cells were observed in the nasal cavity.

[Long-term effect of polystan monocusp ventricular outflow patch after right ventricular outflow tract reconstruction]

Forty-eight patients who underwent right ventricular outflow tract reconstruction with Monocusp Ventricular Outflow Patch (MVOP) fifty-five times and survived surgery, were reviewed in this study. Mean age at surgery was 6.4 years-old and mean follow-up interval was 75.2 months. There was no late death, however reoperation was performed 7 times. Freedom from reoperation rate was 97.2% and 80.7% after 5 and 10 years after surgery, respectively. The main cause for reoperation were right ventricular outflow obstruction RVOTO (5 cases). All of the RVOTO occurred at the distal end of the anastomosis. However, there was no RVOTO in patients who underwent RVOTR with MVOP during the past ten years. So, we considered the cause of RVOTO a technical problem. Pulmonary regurgitation was one to two degree early after surgery, and had worsened by almost two or three degrees more than 5 years after surgery. Moreover, five of six patients who underwent cardiac catheterization more than 10 years after surgery had three degrees of pulmonary regurgitation as well as a large CTR. In conclusion, according to long-term results, especially more than 10 years post operatively, pulmonary regurgitation was the most important problem.

Crescentic glomerulonephritis with positive antineutrophil cytoplasmic autoantibody specific for myeloperoxidase associated with autoimmune hemolytic anemia and thrombocytopenic purpura

A 41-year-old woman was admitted to the hospital with severe uremia, hemolytic anemia, and thrombocytopenic purpura. Emergency hemodialysis with plasmapheresis was started in view of consideration of hemolytic uremic syndrome (HUS), which resulted in improvement of renal function and platelet count. Positive antineutrophil cytoplasmic autoantibody specific for myeloperoxidase (MPO-ANCA) suggested crescentic glomerulonephritis, which was pathologically evidenced by renal biopsy. The diagnosis of MPO-ANCA associated crescentic glomerulonephritis with autoimmune hemolytic anemia (AIHA) and thrombocytopenic purpura were confirmed. Three courses of steroid pulse therapy with heparin were successfully performed, followed by oral prednisolone and warfarin. Such a case has not been previously reported to our knowledge.

[Surgical results of the Senning operation and arterial switch operation for complete transposition of the great arteries]

From March 1980 to August 1997, 42 patients with complete transposition of the great arteries (TGA) type I and II underwent arterial switch procedure (n = 20) or Senning (n = 22) procedure in our institution. In arterial switch procedure group, there were two operative death. No late death occurred, and one patient underwent reoperation and one underwent balloon pulmonary angioplasty for right sided obstruction. The freedom from the intervention rate for right sided obstruction was 83.0% at 5 years, subsequently. In Senning procedure group, operative death occurred in two patients with TGA type II, and one patient with TGA type II and two patients with type I died because of cardiac events in the late stage. In this group, two patients died from accident. The survival rate excluding accidental deaths was 77.7% and 77.7% at 5 and 10 years, respectively. However, those patients who died in the late stage had severe pre-operative and post-operative complication. In conclusion, mid-term results of arterial switch procedure is satisfactory, however, reintervention rate was not so low. Long term results of Senning procedure without preoperative or postoperative complication was satisfactory.

Echocardiographic and pathological evaluation of atherosclerosis in the ascending aorta during coronary artery bypass grafting

We performed intraoperative echocardiography with an epiaortic probe to assess the correlation between echocardiographic appearance and pathological findings of the aorta and to examine the effect of cross-clamping on the aortic wall in 276 patients who underwent coronary artery bypass grafting. The ascending aorta was divided into three segments as follows: lower (L), upper (U), and innominate. The anterior (ant) and posterior (post) intimal thicknesses of each of the three segments were measured. The echogenicity at each of the six locations was examined and was classified as isoechoic or nonisoechoic (hyperechoic, hypoechoic, or mixed type). Tissue punched from the ant L wall of the ascending aorta for vein anastomosis was examined for the presence of atheroma. At the ant L, the prevalence of atheroma was significantly higher in nonisoechoic walls than in isoechoic walls (P = 0.049). We divided patients into two groups according to echogenicity at the U segments. Group A (n = 213) consisted of patients whose echogenicities at both ant U and post U were isoechoic. Group B (n = 63) consisted of patients with nonisoechoic echogenicity at ant U and/or post U. The intimal thicknesses at all six locations in Group B patients were greater than those of Group A (P < 0.01). Deformities at the clamp site after cardiopulmonary bypass were observed significantly more often in Group B than in Group A (P < 0.01). Our data suggest that a nonisoechoic aortic wall indicates more advanced atheroma and a higher risk of deformities at the clamp site. Examination of the echogenicity of the ascending aorta may be one method to reduce perioperative neurological complications.

IMPLICATIONS

We performed epiaortic echocardiography during coronary artery bypass grafting and found that the presence of atheroma and deformities at the cross-clamping site were significantly more prevalent in nonisoechoic walls than isoechoic walls.

[Histoculture drug response assay on non-small cell lung cancer]

We examined the chemosensitivity of non-small cell lung cancer (NSCLC) tissues to CDDP, 5-FU, ADM, MMC, ETP and SN38 using histoculture drug response assay (HDRA). One-hundred and thirty surgical specimens from NSCLC patients who were not given preoperative chemotherapy were used. The inhibition indexes of CDDP, 5-FU, MMC, ADM, ETP and SN38 were 39.1 +/- 18.2%, 48.0 +/- 19.7%, 63.3 +/- 17.7%, 47.6 +/- 22.0%, 36.9 +/- 21.1%, and 37.9 +/- 25.2%, respectively. Inhibition indexes were above the cutoff level, i.e., 'judged sensitive,' in 40 cases (31.3%) for CDDP, 34 cases (27.4%) for 5-FU, 54 cases (44.3%) for MMC, 36 cases (33.0%) for ADM, 29 cases (29.8%) for ETP, and 34 cases (37.4%) for SN38, respectively. In almost one-third of patients, the inhibition indexes of all drugs were under cutoff levels. Correlations between in vitro chemosensitivity data and patient responses to chemotherapy were obtained from 16 evaluable patients, and a 44.4% true positive rate and a 100% true negative rate were observed. Our results with HDRA for NSCLC showed a high incidence of intrinsic multidrug resistance. HDRA may help doctors to avoid non-effective chemotherapy for NSCLC patients.