[Clinical assessment of CAPD (continuous ambulatory peritoneal dialysis) for chronic end-stage renal failure]

Eight patients of end stage renal failure were placed under CAPD (Continuous Ambulatory Peritoneal Dialysis) therapy in our institution. The main indications were difficulty or lack of vascular access. The therapeutic duration ranged from 15 to 2 months and the results described-below were obtained. BUN, Serum Creatinine were well controlled. Hemoglobin & hematocrit increased significantly in most cases. Removal of water and salt was satisfactory. Consequently, limitation of water and salt became unnecessary in all cases. So far protein loss seemed to be a lesser problem, which could be overcome by an adequate protein intake. Catheter troubles and peritonitis were observed in 3 cases respectively but none became the reason for an immediate interruption of CAPD. General well-beings of the CAPD patients improved in a definite degree subjectively and objectively CAPD has been gaining surprisingly fast popularity all over the world but many questions remain presently unanswered: (1) Catheter trouble and peritonitis (long-term survival of the technique) (2) Adequacy of the dialysate constitution (3) Physiological changes of the peritoneum in long-term CAPD (4) Metabolic changes of CAPD patients (5) Drug Kinetics etc. These problems were briefly discussed.

Comparative study of caloric responses induced by different stimulus intensities

Bithermal caloric responses induced by 20, 50 and 240 ml water irrigations were compared in 111 healthy Japanese adults. Distribution mode of max. slow phase eye velocity (SPEV), duration and max. frequency showed normal pattern in the logarithmic scale but not in the regular scale. All three nystagmus parameters of 240 ml caloric test showed most linear distribution compared with two other caloric tests in the probit plots of logarithmic scale. When the mean, coefficient of variation and normal range (mean +/- 2 SD) were compared between two modes of distribution, the most consistent difference was found in the range which was biased to the side of large number with little difference in the width of the range. When one standard deviation of CP- and DP-indexes were compared, these values were smallest in max. frequency, however, the best negative correlation between variation (SD) of CP- and DP-indexes and stimulus intensity was found in SPEV.

Correlation between the level of urinary D-glucaric acid and the degree of activation of masked compound (FT-207) in cancer patients

Phenobarbital stimulates the induction of liver microsomal drug-metabolizing enzyme, namely, cytochrome P-450, which enhances the rate of conversion of FT-207 to 5-FU, the active substance. When FT-207 is administered in combination with phenobarbital to cancer patients, the fluctuation in level of the drug-metabolizing enzyme, cytochrome P-450, should be taken into consideration. Therefore, it was investigated whether the urinary level of D-glucaric acid could be of value as an indicator for the evaluation of the activation of masked compounds, such as FT-207. The level of D-glucaric acid in urine was lower in cancer patients than in normal controls. The correlation between the level of urinary D-glucaric acid and that of 5-FU, which is an active metabolite of FT-207, in blood was statistically significant. The level of D-glucaric acid in urine was of use as an indicator for the evaluation of the activation of masked compounds, such as FT-207, in cancer chemotherapy.

Effects of inducer of liver drug-metabolizing enzyme on blood level of active metabolites of cyclophosphamide in rats and in cancer patients

It was already reported that a masked compound, cyclophosphamide (Endoxan, EX) undergoes the first step metabolism by a drug-metabolizing enzyme in liver microsomes, cytochrome P-450. By pretreatment with phenobarbital as an inducer of P-450, the maximum blood level of active metabolites of EX (normustard-like substances) in normal rats was 2.3 times higher than that in non-treated rats, in conformity with the increase in amount of liver P-450 and in alkylating activity of EX. In YS (Yoshida sarcoma)-bearing rats, the value of liver P-450 went down day by day to 1/2 on the 4th day after inoculation, but it remained normal when animals were pretreated with phenobarbital. In parallel with this, the blood level of normustard-like substances after EX administration was normal or showed a tendency toward increase. In 11 clinical cases pretreated with phenobarbital, the blood level of normustard-like substances 1 to 3 hr after EX administration, at the time when it reaches the peak was 1.5 times higher on an average than that in cases without pretreatment.