[Angiotensin I-converting enzyme gene polymorphism and renal disease]

ACE inhibitor is known to have a therapeutic efficacy in renal diseases by reducing proteinuria and maintaining renal function. However, the relationship between ACE gene polymorphism and renal disease has not been fully elucidated. In this study, a 287 base pair(bp) I/D polymorphism of the ACE gene was examined with polymerase chain reaction(PCR) in 100 healthy subjects, 34 patients with chronic glomerulonephritis(CGN), 29 with chronic renal failure(CRF) and 25 with diabetes mellitus(DM) with(13) and without(12) nephropathy. We also measured serum ACE activity of these patients. ACE genotype and derived allele frequencies in each disease group did not differ significantly from those in healthy subjects. In all disease groups, values of serum ACE activity were higher in genotype DD than in genotype II. These findings suggest no significant association between I/D polymorphism of the ACE gene and renal disease. Further studies are needed to clarify these findings, considering renal function and type of renal disease.

Effects of escins Ia, Ib, IIa, and IIb from horse chestnut, the seeds of Aesculus hippocastanum L., on acute inflammation in animals

We investigated the effects of escins Ia, Ib, and IIb isolated from horse chestnut, the seeds of Aesculus hippocastanum L., and desacylescins I and II obtained by alkaline hydrolysis of escins on acute inflammation in animals (p.o.). Escins Ia, Ib, IIa, and IIb (50-200 mg/kg) inhibited the increase of vascular permeability induced by both acetic acid in mice and histamine in rats. Escins Ib, IIa, and IIb (50-200 mg/kg) also inhibited that induced by serotonin in rats, but escin Ia didn't. Escins Ia, Ib, IIa, and IIb (200 mg/kg) inhibited the hind paw edema induced by carrageenin at the first phase in rats. Escin Ia (200 mg/kg) and escins Ib, IIa, and IIb (50-200 mg/kg) inhibited the scratching behavior induced by compound 48/80 in mice, but escin Ia was weakest. Desacylescins I and II (200 mg/kg) showed no effect. With regard to the relationship between their chemical structures and activities, the acyl groups in escins were essential. Escins Ib, IIa, and IIb with either the 21-angeloyl group or the 2'-O-xylopyranosyl moiety showed more potent activities than escin Ia which had both the 21-tigloyl group and the 2'-O-glucopyranosyl moiety.

Cholecystokinin antagonistic activities of loxiglumide

Cholecystokinin (CCK) antagonistic activities of loxiglumide ((+/-)-4-(3,4-dichlorobenzamido)-N-(3-methoxypropyl)-N-pentylgl utaramic acid, CR1505, CAS 107097-80-3) were investigated in the gastrointestine and gallbladder in vivo. Intravenous administration of loxiglumide antagonized the CCK-induced reduction of gastric emptying in rats, acceleration of intestinal transport in mice, increase in ileal motility in rabbits, gallbladder contraction in guinea pigs and acceleration of gallbladder emptying in mice. Orally administered loxiglumide also antagonized the CCK-induced gallbladder emptying in mice. Furthermore, egg yolk-stimulated gallbladder emptying in mice was also inhibited by loxiglumide, indicating that this agent antagonizes not only exogenous but also endogenous CCK. These results demonstrate that loxiglumide is an intravenously and orally effective, potent CCK antagonist.

[Bioactive constituents of Chinese natural medicines. III. Absolute stereostructures of new dihydroflavonols, hovenitins I, II, and III, isolated from hoveniae semen seu fructus, the seed and fruit of Hovenia dulcis THUNB. (Rhamnaceae): inhibitory effect on alcohol-induced muscular relaxation and hepatoprotective activity]

The methanol-soluble fraction from a Chinese natural medicine Hoveniae Semen Seu Fructus, the seed and fruit of Hovenia dulcis THUNB. (Rhamnaceae) was found to show an inhibitory effect on the alcohol-induced muscular relaxation and a protective activity on the D-galactosamine/lipopolysaccharide or carbon tetrachloride-induced liver injury. Through bioassay-guided separation using a traction performance test, three new dihydrofravonols named hovenitins I, II, and III were isolated from Hoveniae Semen Seu Fructus together with four known flavonoids, (+)-ampelopsin, laricetrin, myricetin, and (+)-gallocatechin. The absolute stereostructures of hovenitins I, II, and III were determined on the basis of chemical and physicochemical evidence to be (2R, 3R)-5,7,4',5'-tetrahydroxy-3'-methoxydihydroflavonol, (2R,3S)-5,7,4',5'-tetrahydroxy-3'-methoxy-dihydroflavonol, and (2R, 3S)-5,7,3',4',5'-pentahydroxydihydro-flavonol, respectively. Hovenitin I and (+)-ampelopsin, both of which were principal ingredients of the active fractions from this natural medicine, were found to show an inhibitory activity on the ethanol-induced muscle relaxation in rats. In addition, hovenitin I showed a protective activity on the liver injury induced by D-galactosamine/lipopolysaccharide or carbon tetrachloride in mice.

[Clinical efficacy of imipenem/cilastatin sodium for respiratory infections in patients with lung cancer]

Imipenem/cilastatin sodium (IPM/CS) was administered to 102 patients with respiratory tract infections and lung cancer. Patients with other serious diseases were excluded and a total of 73 patients were enrolled. They were divided into 12 patients who underwent surgery (operated group) and 61 who did not (non-operated group); the latter group included 28 patients treated with anticancer agents or radiation therapy (treated group) and 33 untreated patients (untreated group). IPM/CS was effective in 75% of the patients, both with and without surgery. The drug was effective in 81% of the treated group, although many of the patients had Stage III or more advanced cancer, as well as bronchial occlusion. IPM/CS was also effective in 69% of the untreated group, although many of the patients have serious infections and a PS (Performance Status) of 3 or greater. Thus, IPM/CS treatment achieved good results. Bacteriological studies showed that 3 out of 4 strains in the operated group and 16 out of 18 in the non-operated group were eliminated. Safety was evaluated in all patients. Two patients (2%) experienced side effects and two others (2%) showed abnormal clinical findings, but the symptoms were mild and resolved after discontinuation or completion of therapy. In conclusion, IPM/CS was very effective for treating respiratory infections in patients with lung cancer.

The significance of esophageal variceal pressure in patients with cirrhosis

We measured the portal circulatory hemodynamic parameters in 10 cirrhotic patients with portal hypertension and esophageal varices to determine the significance of esophageal variceal pressure. In 4 patients (group I), the temporary portal vein occlusion produced significant elevations in both the esophageal variceal pressure and the portal venous pressure. The results of the portal circulatory hemodynamic assessment in this group were consistent with the predominance of the backward flow mechanism. In the remaining 6 patients (group II), however, portal vein clamping resulted in a slightly increased esophageal variceal pressure with an enormous increase in the portal pressure. The forward flow mechanism thus appeared to be predominant in group II. In other words, the results of the pressure measurements were consistent with the functional separation of the hemodynamics in the esophageal varices and portal trunk in group II and the functional hemodynamic continuity in group I. This functional separation between the esophageal varices and the portal trunk in group II might therefore have resulted from the increased blood flow in the lesser splanchnic region.

A new sealing device (Sandwich-disc) for rapid recreation of pneumoperitoneum during laparoscopic assisted surgery

We have developed a new device which enables rapid sealing of a minilaparotomy during laparoscopic assisted surgery to recreate an airtight condition. This device consists of a center rod and two discs (7 cm in diameter) which form an airtight condition by compressing the inner and outer surfaces of the abdominal wall. Advanced laparoscopic procedures requiring both pneumoperitoneum and minilaparotomy are facilitated with the use of this device. This new device is called the Sandwich-disc: Takasago Medical Industry Co., Ltd.

Laparoscopic splenectomy

Laparoscopic splenectomy was carried out for the treatment of patients with splenic disorders; 20 idiopathic thrombocytopenic purpura, 1 hamartoma and 3 hereditary spherocytosis. With the patients in the right lateral position, four trocars were used. Under CO2 pneumoperitoneum with a pressure of 10 mmHg, the surrounding ligaments were divided with electrocautery. At the splenic hilum, the splenic artery and vein were exposed using ultrasonic dissector. After double ligation of these vessels, the spleen was dissected with an autostapler. The resected spleen contained in a nylon bag was fragmented with finger-fracture method and extracted through a port site extended up 2 or 3 cm in length. All the patients tolerated the procedure and no blood transfusion was required. Laparoscopic splenectomy is the preferred choice to resect the spleen because of the short hospital stay, less pain and good cosmesis.

Removal of the preputial glands alters the individual odors of male MHC-congenic mice and the preferences of females for these odors

Inbred mice of MHC-congenic strains prefer to mate with mice of different MHC types. Mate selection based on MHC-type occurs through the urinary odors specific to each MHC-congenic mouse strain. Both urine and preputial gland odors of male mice have been postulated to act as female attractants and the present study examined the attraction of MHC-congenic female mice (C57BL/6J and B6-AKR.H-2k) to the urine and preputial gland odors of males. Females of both strains showed a greater attraction to the urine odors of intact males of the other MHC type, but did not show a preference for the urine odors of these males after their preputial glands were removed. There was, however, a preference for the preputial fluid of males of the other MHC type. These results indicate that the MHC-specific urinary odors of mice may arise from the preputial glands, and that it is the MHC-specific preputial gland odors of MHC-conspecific males that are used for mate selection by females.

[Plasma fatty acids, lipids, lipoprotein and macroangiopathy]

Epidemiological studies have elucidated that diabetes mellitus (DM) is one of the risk factors of coronary heart disease and that DM often accompanies dyslipidemia. Dyslipidemia in DM can be classified as either quantitative or qualitative. Although dyslipdemia in DM is affected by the type of DM and glycemic conditions, the characteristics of dyslipidemia in DM, especially in NIDDM are the increase in triglycerides accompanied by the decrease in HDL-cholesterol level. Recently, new commercial kits for measurement of atherogenic lipoproteins which increase in DM are clinically available. The usefulness of these kits in DM was reviewed. Polyacrylamide electrophoresis can detect IDL and Lp(a) qualitatively. It has also become possible to estimate Lp(a) quantitatively by ELISA, TIA and LIA methods. Remnant lipoprotein can be measured in the fraction unbound to anti-apo A1 and anti-apo B100 antibodies by immunoaffinity gel analysis. Apoproteins, apoprotein E phenotype, post-heparin lipoprotein lipase, and Lp AI (HDL with apo AI and without apo AII) can be measured by the commercially available kits. Modified LDLs (glycated, oxidative) increase in DM, but their measurements remain complicated at the moment. Analysis of plasma fatty acids by gaschromatography is useful for dietary assessment. The measurement of these new markers seems to be useful to assess the extent of atherogenic risk in DM.

Successful treatment of chronic necrotizing pulmonary aspergillosis with intracavitary instillation of amphotericin B--a case report

We present an unusual case of 30-year-old man who was admitted to our hospital with dysesthesia of the limbs and skin eruptions. Polyarteritis nodosa was diagnosed based on the histopathological examination of sural nerve and renal biopsies. A month after initiation of corticosteroid therapy, a small infiltrative shadow was detected in the right mid-lung field by chest X-ray. Aspergillus infection was suspected based on a culture of bronchial lavage fluid. Despite intravenous administration of the antifungal agents, miconazole and fluconazole, a thin-walled cavity with a fungus ball gradually formed in the infiltrative lesion. The patient's clinicopathological findings were consistent with a diagnosis of chronic necrotizing pulmonary aspergillosis, a rare aspergillus infection in the lung. Treatment with intracavitary instillation of amphotericin B proved effective.

Extracellular proteolytic activity of Cryptococcus neoformans

Eight strains of Cryptococcus neoformans var. neoformans isolated from AIDS patients in the Infectious Disease Institute, University of Turin, Italy, were examined for growth and extracellular proteolytic activity in culture with solid and liquid media. All of the strains grew well on Yeast Carbon Base (YCB) agar medium supplemented with both 0.1% (w/v) bovine serum albumin (BSA) and 0.01% (w/v) polypeptone (Pp), and produced a clear proteolytic zone around their colonies, whereas they exhibited less growth and proteolytic activity on YCB medium supplemented with BSA alone. Strain #8 with a strong proteolytic activity was cultured in three different liquid media. Its growth was limited in YCB medium supplemented with 0.1% BSA, but was moderate in that with 0.01% Pp. Enhanced growth was supported by the addition of both BSA and Pp to the YCB medium. The relative value of the final cellular yields obtained with the above YCB-0.1% BSA, YCB-0.01% Pp and YCB-0.1% BSA-0.01% Pp media was approximately 1:10:20. In the culture with YCB medium containing both BSA and Pp, a rapid decrease in the amount of BSA was demonstrated by a spectrophotometric assay and gel electrophoresis of the culture supernatant after the log-to-stationary phase. The proteolytic activity in the culture supernatant became detectable after the log phase when tested with skim milk agarose plates. These results allowed us to conclude that Cr. neoformans var. neoformans is able to secrete protease and to utilize protein as a source of nitrogen.

Cost effectiveness of radiofrequency catheter ablation versus medical treatment for paroxysmal supraventricular tachycardia in Japan

This study evaluated the cost of performing radiofrequency catheter ablation in Japanese patients with paroxysmal supraventricular tachycardia refractory to antiarrhythmic drug therapy in comparison with the cost of continuing pharmacologic treatment. Twenty patients (mean age 44 +/- 14 years) underwent successful ablation: 15 patients with Wolff-Parkinson-White syndrome and five with atrioventricular nodal reentrant tachycardia. The mean duration of symptoms was 77 +/- 60 months. The patients had been treated with 2.6 +/- 1.7 antiarrhythmic drugs before undergoing ablation. Charges derived from hospital bills were compared with the outpatient charges for the year before ablation. The mean hospital stay for the ablation procedure was 4.3 +/- 0.5 days. The mean total charge for ablation was 982,806 yen +/- 103,195, and 5.7 +/- 0.7 times the outpatient charges in the previous year. The majority of radical cure charges were the costs of the electrode catheters used in the ablation procedure. All patients had a successful outcome and required no additional antiarrhythmic drug therapy. If medical treatment were continued without ablation, the mean total life-expectancy charges were estimated at 7,064,726 yen +/- 3,116,621, 41.0 +/- 19.2 times the outpatient charges. The total life charges of medical treatment were significantly more than the total ablation charges (p < 0.001). This study suggests that radiofrequency catheter ablation is of clinical benefit in treating paroxysmal supraventricular tachycardia, and markedly reduces the cost of definitive therapy. This strategy appears to be more economical than pharmacologic treatment.

Complete atrioventricular block during left heart catheterization

A 75-year-old male underwent cardiac catheterization for frequent ventricular premature contractions and reduced left ventricular function. ECG on admission showed complete right bundle branch block (RBBB) and left anterior hemiblock. Right heart catheterization was performed uneventfully, but complete atrioventricular block (CAVB) occurred suddenly when a pig-tail catheter was inserted into the left ventricle. Electrophysiological study identified this CAVB as HV block, and demonstrated HV prolongation in sinus rhythm. The coronary angiogram revealed no obstructive lesion or spasm with ergonovine. The reproducibility of the CAVB was demonstrated. The final CAVB developed and persisted for more than one week, requiring the implantation of a permanent pacemaker (DDD). Complete atrioventricular block induced during left heart catheterization is very rare. Pre-existing RBBB with left anterior or posterior hemiblock and reduced left ventricular function may be common factors in patients with this condition. Emergency pacing equipment should always be on-line when left heart catheterization is conducted in such patients.

Relation between the size of lesions and arrhythmias produced by microwave catheter ablation with a special electrode device

The purpose of this study was to examine the effects of microwave catheter ablation of ventricular myocardium. Microwave energy with a frequency of 2450 MHz was delivered via a coaxial catheter with an electrode ball tip. Microwave energy was applied to canine isolated left ventricular endocardium in vitro and to 6 anesthetized dogs in vivo at 50 watts for 15-150 sec. Ventricular arrhythmia was not observed during ablation in any of the dogs when microwave energy was applied for less than 45 sec. When the duration of microwave ablation was greater than 45 sec, ventricular premature contractions were observed in all of the dogs. Nonsustained ventricular tachycardia developed when the duration of microwave delivery was greater than 90 sec. After the cessation of ablation, ventricular arrhythmias did not occur and ventricular programmed stimulation did not induce ventricular tachycardia in any of the dogs. Except for ventricular arrhythmia, no declines in the hemodynamic status were observed in any of the 6 dogs. The size of the ablated lesion was significantly greater as the duration of ablation was increased (p < 0.05). When ablation lasted for more than 120 sec, the coagulation layer was extended to the epicardium in all 6 dogs. The results of this study suggest that microwave ablation is feasible for the treatment of tachyarrhythmias from deep focus of ventricular myocardium with relatively small proarrhythmic effects.

[An experimental study of catheter ablation using microwave energy via coaxial electrode catheter]

The purpose of this study was to examine the efficacy, arrhythmogenicity, and the size of ablated lesions of catheter ablation with microwave energy. Microwave energy generated by a device with a frequency of 2450 MHz, was delivered via a bipolar electrode coaxial catheter with an electrode ball tip. Microwave ablation was applied (50 watts for 15-150 sec.) on the left ventricular endocardium in 6 dogs. No ventricular arrhythmia occurred during ablation in any of the dogs when microwave catheter ablation was applied for less than 45 sec. However, when the duration of microwave catheter ablation was longer than 45-60 sec, ventricular premature contractions were observed in all 6 dogs. When ablation time was set for a longer time, the dogs developed nonsustained ventricular tachycardias. Nevertheless, ventricular arrhythmias after ablation did not occur in all dogs. Ventricular programmed stimulation after ablation did not induce ventricular tachycardia in any of the dogs. When ablation time lasted more than 120 sec, the coagulation layer was extended to the epicardium in all 6 dogs. The results of this study suggest that microwave ablation is feasible for the treatment of tachyarrhythmias from a deep focus of the ventricular myocardium.

[Lower lung field tuberculosis]

Lower lung field tuberculosis has been considered as rare disease, but it was observed about ten percent in the literature. It seemed that the important problems in lower lung field tuberculosis are delay and difficulty of diagnosis. The materials for this report was accumulated over a period of 10 years, from January 1983 to December 1992 at the National Sanatorium Fukuoka-Higashi Hospital. The criteria for lower lung field tuberculosis are: (1) disease confined to lower lobe except for S6a, middle lobe and lingular segment, (2) bacteriologically and/or histologically proved diagnosis of tuberculosis, (3) clinically considered as tuberculosis for which improved by only anti-tuberculous drugs. During this period, 672 new patients suffering from active pulmonary tuberculosis were admitted to the sanatorium. Of the total of 672 patients, 57 patients were selected as the criteria for lower lung field tuberculosis. The incidence of them was 8.5 percent of the total new admissions. Of these 57 patients, 30 were females and 27 males. The mean age of these 57 patients was 59.4 years ranging between 19 and 86 years. The incidence of them obtained through ten years did not show any tendency to increase or decrease. The respiratory and general symtoms most commonly observed were cough and chest pain. The average duration of used for diagnosis of the lower lung field tuberculosis over 65 years old was 71.7 days and it seemed to show the delay and difficulty of diagnosis.

Optimal frequency of radiofrequency catheter ablation in vitro and in vivo for treating ventricular tachycardias--a study using various frequencies

The purpose of this study was to determine the optimal frequency for radiofrequency catheter ablation of ventricular tachycardias. A radiofrequency current was delivered from a 6F bipolar electrode catheter with a tip electrode width of 4 mm. Ablation was performed for a pulse duration of 10 sec at 20 watts (50 V and 0.4 A) at seven different frequencies between 10 and 500 kHz. We used 35 canine isolated left ventricular endocardial sites in vitro and 14 anesthetized dogs in vivo. The lesions which were ablated at frequencies of 200 and 300 kHz were significantly larger than those at other frequencies, with a mean surface areas of 78.5 and 76.3 mm2, and mean depths of 4.0 and 4.1 mm, respectively (p < 0.05). The appearance of ventricular arrhythmias during ablation increased as the frequency decreased. One dog, to which a frequency of 100 kHz was applied, developed spontaneous ventricular fibrillation and died. All of the dogs which received a current with a frequency under 50 kHz exhibited muscle cramping during ablation. Ventricular stimuli applied after ablation did not induce ventricular tachycardia. These results suggest that the optimal frequency for ablating a large lesion is between 200 and 300 kHz. To avoid inducing malignant ventricular arrhythmia during ablation, the frequency must exceed 200 kHz. Furthermore, a frequency below 100 kHz should not be used in radiofrequency catheter ablation because of the risk of arrhythmias and muscle cramping.

[Borderline values of laboratory data in patients with hyperlipidemia]

In Japanese, serum cholesterol levels have been increasing. This seems to be due to changes in life style, mainly the increase in dietary fat. Epidemiologic studies in the United States and Europe have shown that patients with hypercholesterolemia have a high risk of ischemic heart disease. Some guidelines for the management of hyperlipidemia have been developed in the United States, Europe, and Japan. The National Cholesterol Education Program (NECP) in the United States divides serum cholesterol level into three grades (desirable: below 200 mg/dl, borderline: between 200 mg/dl and 240 mg/dl, hypercholesterolemia: over 240 mg/dl). Borderline serum cholesterol is also a risk, especially in people complicated by other risk factor(s). As most borderline serum cholesterol seems to be due to polygenic hypercholesterolemia, an attempt to change the diet should be the first recommendation for treatment.

[An experimental study on transcoronary chemical ablation: comparison of ventricular tachyarrhythmias induced by chemical ablation according to different chemical materials]

The purpose of this study was to compare heart rate, appearance rate and duration of ventricular tachycardia (VT) by transcoronary chemical ablation using 95% ethanol and 1% aethoxysclerol respectively. After the balloon which was guided to the left or right coronary artery with PTCA technique in anesthetized dogs was inflated, chemical ablation was performed using ethanol (n = 5) or aethoxysclerol (n = 5). These chemicals were administered at 0.05 ml/sec with total dose of 0.50-1.50 ml. A quadripolar electrode catheter was used to record the intracardiac electrogram. VT occurred in all dogs (100%) after the administration of both ethanol and aethoxysclerol. In one dog using ethanol, VT developed into ventricular fibrillation, resulting in death. In dogs using aethoxysclerol, the heart rate and duration of VT were significantly lower and shorter than in those using ethanol (p < 0.05). There were no significant differences determined histologically in the ablated lesions caused by these different chemicals. We conclude that the severity of VT induced in all subjects by chemical ablation is different according to the materials applied, and that aethoxysclerol seems to be safer in comparison with ethanol.

[The influence of repetitive delivery of radiofrequency current in catheter ablation]

The single delivery of radiofrequency current to the cardiac tissue can produce discrete small and shallow area of homogeneous coagulation necrosis. Little is known, however, concerning the influence of repetitive deliveries of radiofrequency current to the identical site of the ventricular myocardium. Therefore, in animal experiments using 8 dogs, we investigated the influences of those applications on the ventricular myocardium from the histological and electrocardiographical aspects. The used frequencies of radiofrequency current were 13.56 MHz (RF-50), 520 kHz (Hatt 200 S) and 500 kHz (LL-50). Released power was 25 Watts in current and 20 seconds in duration. The innings of application were 10, 20 and 30 times per one ablation session. The depth of ablated lesion became greater as the applied innings increased in any generator of radiofrequency current. The ablated lesion by the delivery over 20 times reached from the ventricular endocardium to the epicardium. In contrast, surface area produced by repetitive application was determined by the size and length of the tip of electrode catheter. T wave inversion and isolated premature ventricular contraction on electrocardiogram were observed only during repetitive radiofrequency energy application. Thus, since the repetitive delivery of radiofrequency energy to the identical myocardium caused the deep ablated lesion reached to the epicardium, caution should be taken against myocardial perforation in a clinical setting. However, this application could be useful for the ablation of deeper lesion responsible for ventricular tachycardia.

[Is radiofrequency catheter ablation available for treatment of ventricular tachycardias?--Effects of sequential unipolar applications using multiple electrode catheter]

The purpose of this study was to examine the effects of radiofrequency energy delivered to the canine endocardium in sequential unipolar applications using multipolar electrode catheter for treatment of ventricular tachycardias. Radiofrequency energy generated by the newly designed device (500 kHz) was delivered to the ventricular myocardium by a quadripolar electrode catheter. The device could indicate output and voltage and could calculate myocardial impedance. In order to determine the power of the ablation in vivo, sequential unipolar application was performed with various output in vitro. A continuous endocardial ablation was achieved with output beyond 15 W and with duration of 5 sec per one pole. According to our measurement, the myocardial impedance in vivo was about three times as large as that in vitro. Therefore, minimal output of 45 W in vivo was applied in the same manner in vitro, which resulted in continuous belt-shaped endocardial ablated lesion. Ventricular stimuli after sequential unipolar applications did not induce ventricular tachycardia in any of the dogs. We conclude that radiofrequency sequential unipolar application using the newly designed device produces a large ablated area and may be suitable for ablation of the foci of ventricular tachycardias.

A familial case of hereditary angioneurotic edema in Japan

A 53-year-old man was admitted with impairment of breathing following laryngeal edema. Serum levels of CH50 (22 U/ml), C4 (3 mg/dl), C1-INH protein (10.6 mg/dl) and C1-INH activity (LT 25%) were low. Complement study of the patient's family members revealed that he was one of 5 patients in 3 generations with hereditary angioneurotic edema (HANE). Administration of the androgen derivatives Danazol (600 mg/day) and Oxymetholone (30 mg/day) effectively increased serum levels of C1-INH activity and C4. Though eruption and hepatic dysfunction attributable to administration of the drugs appeared, these side effects improved after withdrawal of the drugs. Subsequently, the treatment with Danazol at a low dose (100 mg/day) was resumed, and the patient has had no episodes of edema for the past 3 years. Regarding the familial cases of HANE, fewer than 20 have been reported in Japan.

[An experimental study on the alteration of myocardial tissue by radiofrequency catheter ablation: differences according to the frequency and the device]

To evaluate the alteration of myocardial tissue by radiofrequency (RF) catheter ablation according to differences of the frequency and the device, we applied RF catheter ablation to canine right ventricular myocardium in vitro. The devices delivering RF energy were LL-49(0. 49MHz, fixed voltage mode), RA-50 (13.56MHz, fixed watt mode) and HAT200 (0.52MHz, fixed watt mode with the capability of temperature adjustment). After RF catheter ablation were performed with a unipolar electrode catheter at various output under the same condition of contact, the ablated lesions by each device were compared. Histologically, we recognized coagulation layer with the necrosis of endocardium and the dissociation of myocardium in each experiment. The degree and the size of ablation layer was significantly larger in lower frequency delivery (p less than 0.05) and was significantly smaller by using the device with temperature adjustment as compared with the others (p less than 0.05). It was suggested that the alteration of myocardial tissue ablated with RF energy differ according to the frequency and the mode of output adjustment of the device.

[Clinical evaluation of sultamicillin in lower respiratory tract infections]

Clinical efficacy and safety of sultamicillin (SBTPC) in patients with lower respiratory tract infections, mainly pneumonia and bronchitis, have been evaluated in a multicenter trial by 19 institutions in the Kyushu area during a period of 12 months from December 1988 to November 1989. 1. Clinical evaluation was made in 132 patients and efficacy rates of SBTPC were 80.0% (28/35) for pneumonia, 78.5% (73/93) for bronchitis and 100% for the remaining 1 patient with other respiratory tract infections. The overall efficacy rate was 79.1% (102/129). 2. Clinical efficacy rate of SBTPC for respiratory tract infections in patients with underlying diseases such as chronic bronchitis, old pulmonary tuberculosis etc., was 75.0% (60/80) which was not significantly different from the efficacy rate of 85.7% (42/49) in patients without underlying diseases. 3. Of 13 patients who failed to respond to previous antibiotic treatments, 8 (61.5%) were effectively treated with SBTPC. 4. Clinical efficacy rates against infections caused by single species of organisms were 90.9% (10/11) for Haemophilus influenzae, 100% (8/8) for Streptococcus viridans and 100% (3/3) for Staphylococcus aureus. The overall clinical efficacy rate in all cases of monomicrobial infections was 88.6% (31/35), in polymicrobial infection 45.5% (5/11) and the overall efficacy rate in cases in which causative bacteria were identified was 78.3% (35/46). 5. Adverse reactions occurred in 6.8% (9/132) of the patients. The symptoms included allergic reaction in 1 patient, gastrointestinal system disorders in 7 patients and general fatigability in 1 patient. As abnormalities in laboratory test values, elevations of A1-P, GOT, and GPT were observed in 3 patients during the study, but returned to normal after discontinuation of SBTPC administration. 6. SBTPC is a useful antibiotic in the treatment of lower respiratory tract infections under the current medical environment where resistant organisms which produce beta-lactamases have been increasing.

A case in which coronary spasms were induced by ergonovine provocation at the sites of coronary artery ectasia

We experienced a patient in whom coronary spasms were induced by an ergonovine provocation test during coronary angiography at the sites of coronary artery ectasia. The patient was a 45-year-old male with chest pain at rest, which promptly disappeared when given sublingual nitroglycerin. Similar attacks occurred frequently even with the administration of drugs after admission, but no significant changes were observed in electrocardiography (ECG) during the attacks or by repeated Holter ECG. The results of exercise ECG and provocation tests such as Valsalva maneuver, hyperventilation, and cold pressor test were negative. Coronary angiography showed ectatic changes in the left coronary artery, and the coronary spasms were induced by ergonovine administration at the ectatic portion of the left anterior descending artery and left circumflex artery, and right coronary artery with chest symptoms similar to those observed during spontaneous attacks. However, there were no significant changes in ECG. This rare case suggests an involvement of spasms in the pathogenic mechanism of myocardial ischemia in coronary artery ectasia.

A consideration of salt intake from foods based on the simultaneous measurement of sodium and chlorine by neutron activation analysis

Ordinary hospital meals for adults were simultaneously measured for Na and Cl by neutron activation analysis (NAA). Results obtained are summarized as follows: 1. Daily Na intake was estimated to be 4 to 8 g, corresponding to 11 to 18 g of salt. Daily Cl intake was estimated to be 5 to 9 g, corresponding to 7 to 12 g of salt. Their ratio was 1.6. 2. The higher values of salt intake obtained by conversion from Na intake are attributable to food additives. 3. In rating Na content, which has been reported to affect blood pressure, on the basis of salt intake, attention must be given to the fact that salt content converted from Cl content is rated to be lower than that converted from Na content.

[Two cases of acute coronary occlusion after successful coronary angioplasty associated with a treadmill stress testing]

We presented two cases of acute coronary occlusion after successful percutaneous transluminal coronary angioplasty (PTCA) associated with a treadmill stress testing. Case 1: A 54-year-old man with effort angina was referred to our hospital for cardiac catheterization. At the time of cardiac catheterization, the proximal RCA had a 99% diameter narrowing, and the proximal LCX had a 90% diameter narrowing. PTCA was performed and both lesions were successfully dilated. Eight days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 173/min (103% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 140 mmHg. A few minutes after the end of exercise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads II, III, aVF and ST depression in leads V4-V6. Emergency coronary angiography disclosed an acute coronary occlusion of RCA at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated. Case 2: A 68-year-old man was referred to our hospital for cardiac catheterization a month after subendocardial anterior myocardial infarction. At the time of cardiac catheterization, the proximal LAD have a 99% diameter narrowing. PTCA was performed and the lesion was successfully dilated. 18 days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 158/min (102% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 218 mmHg. Ten minutes after the one of 218 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Syntheses and platelet aggregation inhibitory and antithrombotic properties of [2-[(omega-aminoalkoxy)phenyl]ethyl]benzenes

A series of [2-[(omega-aminoalkoxy)phenyl]ethyl]benzene derivatives were synthesized and evaluated for their ability to inhibit collagen-induced platelet aggregation in vitro and to protect experimental thrombosis in mice. The results showed that the compounds were in vitro inhibitors of collagen-induced platelet aggregation. Most of them were also effective in the mouse antithrombotic assay. The compounds were found to be potent antagonists to S2 serotonergic receptor, and good correlation (r = 0.85) between their S2 serotonergic receptor antagonism and their potency as platelet antiaggregatory drugs was observed. Among the compounds studied, mono[2-(dimethylamino)-1-[[2-[2-(3- methoxyphenyl)ethyl]phenoxy]methyl]ethyl] succinate hydrochloride (12b, MCI-9042) was selected for further pharmacological and toxicological evaluation.

Neutron activation analysis of manganese contents in ordinary hospital meals

Neutron activation analysis (NAA) was applied to measurement of manganese (Mn) content in food as an example of ordinary hospital meals. The results showed that: 1. NAA permits measurement of Mn with a simple pretreatment procedure in comparison with AAS (atomic absorption analysis). 2. Daily Mn intake was estimated to be about 3 mg from food, and about 4 mg from green tea. Neutron activation analysis (NAA) has been used for measuring various elements under the conditions appropriate for the irradiated or radioactivated subject of analysis. We presently applied NAA to measurement of manganese (Mn) contents in food as an example of ordinary hospital meals with an estimation of daily Mn intake.

[Clinical evaluation of sulbactam/cefoperazone in lower respiratory tract infections]

Clinical evaluation, safety and kinetics in serum of sulbactam/cefoperazone (SBT/CPZ) in patients with lower respiratory tract infections have been studied in a multicenter trial participated by 28 institutions in Kyushu area during a period of 13 months from March 1987 to March 1988. 1. Mean peak serum levels of SBT and CPZ in 35 patients up to 4 hours after intravenous infusion of 2 g of SBT/CPZ were 38.2 +/- 17.3 micrograms/ml for SBT and 104.3 +/- 31.4 micrograms/ml for CPZ. Serum half-lives of SBT and CPZ were 0.76 hour and 1.53 hours, respectively. These results were in similar ranges to those reported elsewhere for SBT/CPZ. 2. Serum half-lives of SBT and CPZ after intravenous infusion of 2 g of SBT/CPZ were not significantly prolonged in patients with moderate liver or kidney dysfunctions. 3. Clinical efficacy rates of SBT/CPZ in 217 patients were 93.1% (81/87) for pneumonia, 93.3% (14/15) for lung abscess, 78.9% (15/19) for acute exacerbation of chronic bronchitis, 57.1% (4/7) for diffuse panbronchiolitis, 72.4% (21/29), 74.4% (32/43) and 100% (9/9) for infections concurrent to bronchiectasis, chronic respiratory disease and pulmonary emphysema, respectively. Those were 50% (1/2) for bronchitis associated with lung cancer and 66.7% (4/6) for empyema. The overall efficacy rate was 83.4% (181/217). 4. Clinical efficacy rate of SBT/CPZ for pneumonia in patients with underlying diseases such as lung cancer, pulmonary tuberculosis and pneumoconiosis, etc, was 85.3% (29/34) and was not significantly different from the efficacy rate of 98.1% (52/53) in patients without these underlying diseases. 5. Of 30 patients who failed to respond of previous antibiotic treatments, 21 were effectively treated by SBT/CPZ. 6. Bacteriological eradication rates against Pseudomonas aeruginosa, Haemophilus influenzae and Streptococcus pneumoniae were 42.9% (9/21), 87.5% (14/16) and 100% (5/5), respectively. The overall eradication rate in all cases including polymicrobial infections was 72.8% (67/92). 7. The high levels of peak serum concentration of CPZ, and the difference between serum levels of SBT and of CPZ seemed to contribute to the high clinical efficacy. 8. Adverse reactions occurred in 2.8% (6/217) of the patients, and consisted primarily of rash and diarrhea. Laboratory abnormalities were observed in 8 patients during the study. These were elevations of S-GOT and S-GPT, and eosinophilia. 9. SBT/CPZ is a very useful drug in the treatment of lower respiratory tract infections as it has become available just in time when increase in resistant organisms to beta-lactams is notable.

Immunopharmacological studies on TBX, a new antiallergic drug (4). Effects on type II to IV allergic reactions and immunological functions in animal models

The effects of 9-methyl-3-(1H-tetrazol-5-yl)-4H-pyrido[1,2-a]pyrimidin-4-one potassium salt (TBX) on type II to IV allergic reactions and immunological functions were investigated in animal models. Types II to IV allergic reactions in rodents were unaffected in vivo by TBX, even at higher doses than those capable of completely inhibiting the type I allergic reaction. However, both complement-mediated hemolysis via the classical pathway and hypotonic shock-induced hemolysis were slightly inhibited in vitro only by a high concentration of the drug (10(-4) g/ml). In the mouse system, TBX had no ability to suppress anti-hapten IgE antibody formation as well as hemagglutinin formation and to inhibit the proliferation of spleen cells induced by non-specific T and B cell mitogens. The results obtained indicate that TBX is an antiallergic drug essentially devoid of inhibitory actions on types II to IV allergic reactions and immunological functions, thus indicating that it is a specific inhibitor of type I allergic reactions.

Immunopharmacological studies on TBX, a new antiallergic drug (3). Inhibitory effects on histamine release from lung fragments and bronchoconstriction in guinea pigs

The effects of 9-methyl-3-(1H-tetrazol-5-yl)-4H-pyrido[1,2-a]pyrimidin-4-one potassium salt (TBX), a new antiallergic drug, on histamine release from lung fragments, experimental asthma and isolated tracheal muscle were investigated in guinea pigs. TBX (10(-7) to 10(-4) g/ml) dose-dependently inhibited antigen-induced histamine release from lung fragments of guinea pigs passively sensitized with homologous IgE serum. Antigen inhalation-induced experimental asthma in passively sensitized animals was inhibited in a dose-dependent fashion by i.v. (1 to 5 mg/kg) and p.o. (10 to 100 mg/kg) administrations of TBX. In vivo bronchoconstriction by platelet-activating factor (PAF, i.v.) was also inhibited by TBX (0.3 to 10 mg/kg, i.v.). However, high concentrations of TBX (more than 3 x 10(-4) g/ml) were needed to inhibit PAF-induced platelet aggregation in vitro. With regard to the effect on isolated tracheal muscle, TBX itself at concentrations higher than 10(-5) g/ml induced dose-dependent reduction in the resting tonus, which was not affected by pretreatment with propranolol. Neither the leukotriene D4-induced contraction nor the prostaglandin F2 alpha-induced one was specifically antagonized by TBX. The results obtained indicate that TBX is an antiasthmatic agent effective in inhibiting both IgE- and PAF-induced bronchoconstriction, possibly by interfering with mediator release.

[A case of giant leiomyoma of the esophagus]

A 34-year-old man was admitted to our hospital because of a tumor shadow in the posterior mediastinum. Leiomyoma of the esophagus was suggested by the findings of CT, esophagography, and esophagoscopy. He underwent thoracotomy. The operative procedure was enucleation of the tumor. The histological examination confirmed it to be a leiomyoma. The postoperative course was uneventful, and the passage of the esophagus was good. He was discharged 36 days after the operation.

[A case of intermittent ventricular pre-excitation syndrome with a Mahaim fiber]

A 61 year-old woman with intermittent ventricular pre-excitation syndrome using a Mahaim fiber was reported. The electrocardiogram showed QRS-complex with small delta wave (100 msec in QRS width) or without small delta wave (80 msec in QRS width). On electrophysiological study, during sinus rhythm, A-H interval was 100 msec. H-V intervals were 25 msec in QRS-complex with small delta wave and 45 msec in QRS-complex without small delta wave. From these findings, it was considered that the small delta wave was produced by a Mahaim fiber.

Effects of heart rate and diltiazem hydrochloride on alternans of ST segment elevation and ventricular arrhythmia during acute myocardial ischaemia in dogs

Although the incidence of ventricular arrhythmias following myocardial ischaemia lessens as ischaemia improves, it is not clear whether this is correlated with a reduction in the degree of ST segment elevation. To explore this further we examined the effects of change in heart rate and the administration of the calcium antagonist diltiazem, 0.02 mg.kg-1.min-1, on ST segment elevation and the alternans of ST segment elevation (STA) and on serious ventricular arrhythmia induced by 10 min occlusion of the left anterior descending coronary artery in 86 mongrel dogs. The dogs were divided into three groups: 26 dogs paced at a rate of 180 beats.min-1 (group A); 44 dogs paced at a rate of 120 beats.min-1 (group B); and 16 dogs paced at a rate of 180 beats.min-1 and given diltiazem intravenously from 25 min before the coronary occlusion (group C). The degree of ST segment elevation and STA within 3 min of ischaemia was significantly lower in group B than in group A. There was no marked difference in the degree of ST segment elevation between groups A and C, but the STA was lower in group C than in group A. Incidence of ventricular tachycardia and ventricular fibrillation was significantly lower in groups B and C than in group A, and the timing of their first appearance was 4.5 (SEM 0.6), 4.2(0.9) and 3.0(0.4) min, respectively. We suggest that the reduction in serious ventricular arrhythmias associated with the decrease in heart rate was caused by the improvement of STA secondary to the improvement of ST segment elevation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical efficacy of fluconazole in the patient with pulmonary mycosis]

Fluconazole, a novel triazole antifungal agent, was given orally or intravenously to 10 patients with pulmonary mycosis (7 patients with primary pulmonary cryptococcosis and 3 with pulmonary aspergillosis). Routes of administration were changed in some patients depending on their condition. Two patients from whom foci was removed by surgical operations were excluded from the efficacy assessment. Clinical efficacies in the remaining 8 patients were good in 2 cases and fair in 3 cases of pulmonary cryptococcosis; excellent in 1 case of pneumonia due to Aspergillus; and fair in 1 case and poor in the other case of pulmonary aspergilloma. Side reactions developed in 9 patients who received intravenous drip infusion were nausea or loss of appetite in 3 patients, fever and/or feverish sensation in 3, vascular pain in 1 and diarrhea and eruption in 1. In the patient who reported fever the drug was discontinued and in the patient who complained of pain at the site of injection, dosing was changed to the oral route but was discontinued due to elevated GOT, GPT, Al-P and gamma-GTP. Seven patients who received the drug orally did not report side effects except 2 patients. None of these side effects reported was serious and from the above results, fluconazole was considered to be a useful agent for the treatment of pulmonary mycosis.

[Experimental and clinical studies of flomoxef in the field of obstetrics and gynecology. Representative Committee Members of the Research Team for Infections in the Field of Obstetrics and Gynecology]

Flomoxef (FMOX) has a broad antibacterial spectrum against Gram-positive and Gram-negative bacteria; especially its potent antibacterial activity against Staphylococcus aureus is a significant advantage that may not be found with other cephem compounds. In our determination of its antibacterial potency against various clinical isolates obtained from clinical materials (amniotic fluid, intrauterine secretions, exudates of the pelvic dead space) of patients with various infections, we obtained results representing specific features of this drug. From the results, the drug may be expected to produce an excellent effect in the treatment of various infections. Our study on drug concentrations in body fluids and genital tissues demonstrated a good transfer of this drug into various tissues; in every tissue examined, the drug administered by the usual method in the usual dose yielded a concentration exceeding MIC for principal pathogens, thus promising a good clinical response. Indeed a high clinical efficacy rate of 90.1% (good to very good responses) was obtained in a clinical trial involving 222 cases. Administration of the drug in 2 g quantity daily produced a high response rate of 92.8%. It was especially noteworthy that a good response was obtained in 30 of 32 cases (93.8%) in which other cephem compounds had failed. In evaluation of the bacteriological effect, furthermore, the drug showed an excellent rate of bacterial elimination. In conclusion, this drug is expected to be greatly useful in the light of its good transfer into genital tissues and its strong antibacterial activities against Gram-positive cocci, Gram-negative bacteria and anaerobes as well as against multiple bacterial infections predominating among women with genital infections.