The amplitude of synchronized cardiac sympathetic nerve activity reflects the number of activated pre- and postganglionic fibers in anesthetized cats

In order to obtain information regarding the number of pre- and postganglionic fibers that are firing, we measured cardiac sympathetic nerve activity (CSNA) before and after the successive sectioning of T1-T5 thoracic rami in anesthetized cats. Total activity from the area was measured under the mean CSNA curve. Peak amplitude, width and periodicity of the synchronized discharge was analyzed from the CSNA curve by the method we developed. Total CSNA decreased to 91 +/- 6%, 63 +/- 6%, 27 +/- 10%, 8 +/- 6% and < 1% of the control due to successive section of the T5, T4, T3, T2 and T1 rami, respectively. The peak amplitude of synchronized CSNA decreased to 95 +/- 6%, 73 +/- 8%, 40 +/- 5% and < 10% of the control value, due to section of the T5, T4, T3 and T2 rami, respectively. The control width was 107 +/- 8 ms and decreased to 106 +/- 1 ms, 92 +/- 6 ms and 68 +/- 5 ms by successive section of the respective T5, T4 and T3 rami. However, periodicities of 80-120 ms (Tc rhythm) and 140-500 ms (Tb rhythm) of synchronized CSNA remained unchanged after section of the T3-T5 rami. The total CSNA decreased gradually due to decreases in the peak amplitude and width of synchronized CSNA with the successive section of preganglionic fibers. These results indicate that the peak amplitude of synchronized CSNA reflects the number of pre- and post-ganglionic fibers that are firing and suggest that the number of preganglionic neurons which activate the cardiac fibers naturally was largest in the T3 segment.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of mediastinal neurinoma originated from the left vagal nerve]

A 46-year-old man was admitted to our hospital because of an abnormal shadow on the chest roentgenogram. The operation was performed through left posterolateral thoracotomy. A tumor mass, 4.5 x 2.5 x 2.5 cm in size, was found and its origin was the left main vagal nerve 0.5 cm distal the branching root of the recurrence nerve. The tumor and a part of the left vagal nerve was resected en bloc. Pathological study revealed tha the tumor was neurinoma of Antoni A+B. Postoperative course was uneventful. This is the 34th reported case in Japanese literature of neurinoma with its origin from the intrathoracic vagal nerve.

[Surgical treatment of metastatic lung tumors]

From January 1970 to March 1991, 72 operations in 55 patients (31 males and 24 females) with metastatic lung tumors were performed in our department. Their cumulative survival rates was 25.5% at five years. With analysis of the various prognostic factors, patients both with solitary metastases and without lymph node metastases had a good prognoses. However, even in patients with recurrent lung metastatic tumors, long time survival was achieved with reoperation in two patients. We concluded that reoperation with or without effective chemotherapies was effective in selected patients.

Nitric oxide mediates cat hindlimb cholinergic vasodilation induced by stimulation of posterior hypothalamus

The aim of this work was to examine whether endothelium-derived relaxing factor (nitric oxide) mediates cat hindlimb cholinergic vasodilation induced by stimulation of the posterior hypothalamus and beta-adrenergic vasodilation by I.V. injection of isoproterenol using an inhibitor of nitric oxide synthesis, NW-nitro-L-arginine methyl ester (L-NAME). Without L-NAME, femoral blood flow velocity (FBV) increased during hypothalamic stimulation by 11.2 +/- 2.2 cm/s (mean +/- SEM) from the baseline value of 8.4 +/- 2.2 cm/s and femoral conductance (FC) increased by 0.084 +/- 0.021 cm/s/mmHg from 0.062 +/- 0.016 cm/s/mmHg, which were abolished by atropine (0.5 mg I.A.). Arterial blood pressure (AP) and heart rate (HR) increased during hypothalamic stimulation (15 +/- 8 mmHg and 22 +/- 6 beats/min). When isoproterenol (1-2 micrograms I.V.) was injected, FBV and FC increased 5.1 +/- 0.56 cm/s and 0.048 +/- 0.005 cm/s/mmHg. With L-NAME (20-100 mg I.A.), the rises in AP and HR during hypothalamic stimulation were unchanged but the increases in FBV and FC were significantly blunted to 5.2 +/- 3.7 cm/s and 0.026 +/- 0.021 cm/s/mmHg. In contrast, L-NAME did not affect the responses in FBV and FC during stimulation of beta-adrenergic receptors. The effect of NG-monomethyl-L-arginine (10-30 mg I.A.) was the same as L-NAME. It is suggested that nitric oxide is involved in hindlimb cholinergic vasodilation neurally induced by hypothalamic stimulation but not in beta-adrenergic vasodilation.

Selective and tone-dependent vasodilation of arterial segment in rabbit and feline pulmonary microcirculation in response to ANP

Using an X-ray television system, we directly measured the changes in internal diameter (ID; 100-600 microns) of small pulmonary arteries and veins in response to intravenous infusion of atrial natriuretic peptide (ANP) in anesthetized rabbits and cats. Under physiological conditions, ANP (0.01-1 micrograms/(kg.min) for 3 min) increased the ID of the small arteries in a dose-dependent manner by 4-9% and by 6-14% in the rabbit and cat, respectively. The maximum increase in ID occurred in the 400-600 microns arteries. In the small veins, however, the peptide had no significant effects on the ID. To simultaneously investigate the ANP-induced responses of pulmonary vessels with different vascular tone in a given lung region, we embolized a part of the rabbit pulmonary vascular tree with micro-beads (80-100 microns diameter) and measured ID responses to ANP (1 microgram/(kg.min) for 3 min) in the embolized vessels with elevated tone and the nonembolized vessels with baseline tone. In the embolized arteries, which had constricted by 31%, ANP induced 27% increase in ID, while in the nonembolized arteries it caused 8% increase in ID. This indicated that in the small arteries, the vasodilator activity of ANP is greatly enhanced under the conditions of elevated vascular tone. In the small veins, however, no significant vasodilation occurred even under the elevated-tone conditions. We concluded that ANP dilates the arterial segments in the rabbit and cat pulmonary microcirculation selectively and in a dose-dependent manner. Furthermore, the pulmonary vasodilator effect of ANP was dependent on the pulmonary vascular tone.

[Irritable bowel syndrome in children]

The irritable bowel syndrome (IBS) is characterized by alteration in bowel habits (i.e., constipation and/or diarrhea) and abdominal pain, and is most common gastrointestinal disorder in adults. The recurrent abdominal pain (RAP) in children is similar to IBS in adults except bowel habits, but there is no settled conception of IBS in children. In our department, diagnosis of pediatric IBS will be made if the child has; #1 functional gastrointestinal disorders without organic diseases, #2 abdominal pain and other gastrointestinal symptoms continuing more than 3 weeks, #3 psychogenic background factors. We experienced 63 cases of IBS (23.5% in all 268 cases) from April 1990 to March 1992 at our pediatric digestive outpatient clinic. They ranged from 4 to 15 years old and about 60% of them were elder than 13 years old. Psychogenic factors were usually related to environment of school life and home. Careful history taking and routine examination were most important for the diagnostic approach. Management of this disease included counseling and drug therapy. Almost all cases reached much better condition 1 to 6 weeks after the therapy started. The combination therapy with psychologist was required in a few cases.

Efficient selection of mu m-mutants from mu m-expressing myeloma cells by treatment with ricin A-conjugated anti-mu antibody

We have developed an efficient system for obtaining myeloma mutants defective in trans-acting factors required for immunoglobulin (Ig) gene expression. The system consists of a myeloma cell line designed for this purpose and an efficient method for selecting mutants from it. The cell line is X63.653 transfected with the mu gene, whose tailpiece sequence was replaced with the transmembrane sequence of human EGF receptor to hold mu on the cell surface and whose CH1 sequence was removed to prevent mu from being retained in the endoplasmic reticulum. It efficiently and stably expressed mu chains of IgM on the cell surface (mu m+) without light chains. To obtain mutants lacking mu m (mu m-) from the mu m+ cell line by selectively killing mu m+ cells, a method with ricin A-conjugated anti-mu antibody was more reliable than complement lysis mediated by anti-mu antibody. Applying the system, we obtained a variety of mu m- mutants.

[Pneumonectomy for destroyed lung or chronic tuberculous empyema]

Fourteen patients underwent pneumonectomy for destroyed lung or tuberculous empyema at the Shimada Municipal Hospital from September 1980 to December 1985. Mean age was 61 and ten patients were males. Cough and sputum (in 12 cases) and hemosputum or hemoptysis (in 8 cases) were common complaints. Three patients had complications in the immediate postoperative period: hemorrhagic shock, pulmonary embolism and contralateral pneumothorax. They were treated conservatively. The postoperative course was uneventful in the other patients and all complaints were reduced or disappeared. And lung function improved in 3 cases with chronic empyema compressing the mediastinum. In conclusion, pneumonectomy is one of the radical operation for destroyed lung or chronic tuberculous empyema with low pulmonary function and complaints. And the critical level are 40% of %VC and 25% of FEV1.0/pr. %VC in preoperative pulmonary function.

A farnesyl arabinoside as an enhancer of glucose transport in rat adipocytes from a soft coral,Sinularia sp

Separation of a lipophilic extract of a soft coral, Sinularia sp., assayed by enhancement of glucose transport in rat adipocytes, gave farnesyl 4-O-beta-D-arabinopyranosyl-beta-D-arabinopyranoside-2,2',3- triacetate (1a) whose structure was determined by spectroscopy. Enhancers of glucose transport may be useful for the prevention and treatment of diabetic disorders.

Statistical analysis of clinical risk factors for coronary artery spasm: identification of the most important determinant

Coronary artery spasm plays an important role in acute ischemic events, and it has a close relationship with coronary atherosclerosis. Thus we attempted to determine the most significant risk factor for coronary artery spasm. Among 3000 consecutive patients who underwent coronary cineangiography with ergonovine maleate testing, 330 with typical angina pectoris (group 1) and 294 with old myocardial infarction (group 2) were studied. We divided each group into three or four subgroups according to the presence of fixed organic stenosis (FOS+) or a positive reaction to ergonovine maleate (coronary artery spasm [CAS]+). We examined the relationship between coronary artery spasm and eight coronary risk factors: age, sex, hypertension, diabetes mellitus, smoking, and serum cholesterol, uric acid, and high-density lipoprotein cholesterol levels. The proportion of smokers in the subgroups with CAS(+) was significantly higher than in the subgroups with CAS(-)(p less than 0.01). There was no correlation between smoking and fixed organic stenosis. According to the results of multiple regression analysis, there was a positive correlation between smoking and CAS(+) and between serum high-density lipoprotein cholesterol levels and CAS(+)(p less than 0.01). Thus we concluded that smoking is the most significant risk factor in discriminating between patients with and without coronary artery spasm.

[Flow cytometric analysis of platelets in patients with variant thrombasthenia]

Three cases of suspected variant thrombasthenia patients (out of 10 cases of Glanzmann's thrombasthenia), who had significant amounts of platelet GPIIbIIIa, underwent flow cytometry to analyse the binding capacity of monoclonal antibodies against GPIIbIIIa to platelets. The monoclonal antibodies used in this study were as follows: PLT-1 and AP-2 recognizing the IIbIIIa complex; TP 80, P2 and AP-4 recognizing IIb:;AP-5 recognizing IIIa;OP-G2, which binds an epitope near the RGD binding site and 3F11. OP-G2 also recognizes conformational changes of activated platelets by increased binding. Case 1 platelets showed a binding capacity of 28-63% of that of normal platelets for TP80, AP-2, AP-4, and 3F11, but no binding to OP-G2. Case 2 platelets also showed 16-44% binding with TP80, AP-2, AP-4, AP-5, and 3F11, but no binding to OP-G2. These findings indicated the presence of structural abnormalities of the functional site of platelet GPIIbIIIa in cases 1 and 2. Case 3 platelets bound with all monoclonal antibodies normally, but normal increase in the binding of OP-G2 to platelets activated by thrombin or ADP was not seen, indicating a lack of activation of the fibrinogen binding site of platelet GPIIbIIIa.

[The role of surgeon in treatment of chronic respiratory failure after pulmonary tuberculosis operations]

We analyzed pulmonary functions and rib cage-phrenic motions on 296 cases of chronic empyema patients who had surgical treatment. Pulmonary functions were better preserved in patients with a single step than in those with multi-step operations, and in those who had more than five operations the impairment was inevitable. Both %VC and rib cage-phrenic motions improved by decortication, and by air-plombage, but in those who developed multi-rib fractures after the latter procedure, ipsilateral chest wall motion almost disappeared. Since some restriction of rib cage-phrenic motion is inevitable after the surgery, we have developed a cuirass respirator which can synchronize with the respiration to assist the movement of the chest wall. The results attained so far are satisfactory.

Progression of coronary atherosclerosis: is coronary spasm related to progression?

A total of 239 patients undergoing serial coronary angiography with a concomitant ergonovine provocation test were studied between July 1974 and June 1987. The progression of coronary artery disease was evaluated in relation to risk factors, especially coronary artery spasm. Patients were classified into three groups: 1) new myocardial infarction group (39 patients); 2) progression without infarction group (90 patients); and 3) nonprogression group (110 patients). To assess how risk factors and coronary spasm are related to the occurrence of new myocardial infarction and progression without infarction, 11 variables in the three groups were examined: age, gender, the time interval between the studies, fasting blood sugar, systolic blood pressure, diastolic blood pressure, smoking, serum cholesterol, triglyceride, uric acid and a positive response to the ergonovine provocation test. Multiple regression analysis selected three independent predictors of progression without infarction: cholesterol (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). Multiple regression analysis also selected three independent predictors of the occurrence of new myocardial infarction: fasting blood sugar (p less than 0.01), systolic blood pressure (p less than 0.05) and a positive response to the ergonovine provocation test (p less than 0.001). A positive response to the ergonovine provocation test was the strongest factor for occurrence of both new myocardial infarction and progression without infarction. To evaluate segmental arterial changes, 3,275 coronary artery segments were analyzed in the 239 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Flow cytometric analysis of platelets in patients with Glanzmann's thrombasthenia]

Platelets from 10 patients with Glanzmann's thrombasthenia (7 patients with type I and 3 with type II) and their 18 family members (11 parents, 6 siblings and one daughter) were analyzed by flow cytometry using 3 different commercially available FITC-labeled monoclonal antibodies. The amount of platelet GPIIbIIIa was calculated by using the ratio of the fluorescence intensity of the mean channel in comparison to normal platelets. The amount of platelet GPIIbIIIa was lower than 19% in 6 patients with type I and one patient with type II thrombasthenia. One type I patient had a 46.5% GPIIbIIIa amount as assessed using the monoclonal antibody TP80 (Nichirei Corp. Japan) which recognized GPIIb, although the other 2 antibodies showed an amount of less than 5%. One type II patient showed the following results: 30.9% (TP80), 28.2% (P2 antibody, Immunotech, France), and 3.9% (PLT1, Coulter Immunology, USA). The remaining type II patient consistently showed a normal amount of platelet GPIIbIIIa using all antibodies, appeared to be a variant form of thrombasthenia. The parents of type I patients had a significantly lower amount of platelet GPIIbIIIa compared to normal and 2 siblings of type I patients were diagnosed as heterozygotes. These findings suggest that Glanzmann's thrombasthenia is more heterogeneous than we have previously suspected, and that flow cytometric analysis using different monoclonal antibodies is a useful tool for identifying those heterogeneities and for the detection of type I carriers.

[A loco-regional cancer chemotherapy, using a fibrin clot as a drug carrier--the oncolytic effects and putative mechanisms]

Anticancer drug (AD), adriamycin (ADM) or cisplatinum (CDDP) were individually encapsulated into an insoluble fibrin clot (FC), using our own technique. FC-ADM or FC-CDDP was intraabdominally placed in AH 130-bearing rats, and ADM or CDDP solution was intraabdominally injected (IP) into other cancer-bearing rats. The survival time was recorded and related oncolytic mechanisms were investigated. Eleven of 14 rats treated with FC-CDDP, and four of eight rats given FC-ADM, survived for more than 200 days. In these animals, the ascites disappeared within 10 to 14 days after the treatment, and there was neither a recurrence of ascites nor metastases. Eight of these rats underwent challenge of AH 130 cells. All the challenged animals revealed no evidence of recurrence of the cancer and showed a killing activity against the AH 130 cancer cells. Survival time in the other cancer-bearing rats was shorter than three weeks, and the direct cause of death was cachexia. Our newly devised FC-AD showed high activity against implanted AH 130 tumors. These activities are attributed to both a sustained release of AD and immunoresponses induced with FC-AD.

A newly designed anticancer tumor immunity drug delivery system

The authors used a fibrin clot (FC) as a carrier of an anti-cancer drug (AD) to achieve sustained release of the drug. Adriamycin (ADM) and cis-platinum (CDDP) were individually encapsulated into an FC, and the profile of release of each AD from the FC-AD was examined in vitro. The FC-AD was placed intra-abdominally in ascites hepatoma AH130-bearing rats, and ADM or CDDP solution was intraperitoneally injected (IP) into other cancer bearing rats. The survival time was recorded, and related oncolytic mechanisms were investigated. The release of AD from the FC continued for over 15 days. Sixty-eight percent of the rats treated with FC-AD survived for more than 200 days and evidence of malignancy disappeared. Almost all of the IP rats and non-treated rats died within 20 days; these animals had massive ascites and extensive metastases. Immunologic studies confirmed that various tumor immunoresponses were induced in the rats treated with FC-AD. The FC-AD system warrants further study for possible antineoplastic activities in vivo.

[A case of tuberculous osteomyelitis resembling metastatic cancer on bone scintigraphy]

A 48-year-old male was referred to our division, on the suspicion of lung cancer with bone metastasis. Chest radiography showed a mass shadow and bone scintigram demonstrated multiple scattered regions of increased uptake. However bronchial and bone biopsy specimens revealed granuloma with epithelial cells and giant cells. A diagnosis of tuberculous osteomyelitis was made, and antituberculous therapy was begun. Chest radiography and bone scintigrams one year later showed marked improvement.

[Relationship between the total IgE levels and specific IgE antibodies]

In this study, nine allergens were selected; i.e. 1289 cases of d1, 1277 cases of e1, 1547 cases of f1, 1063 cases of t17 and others, for investigating the relationship between the total IgE level and RAST score. The results showed that the total IgE level was high in high d1 score, and 29 cases of low IgE level were observed in high f1 score groups. On the other hand, the comparison of the CAP system and the total IgE level showed. The result shows that one case of low total IgE value was found in highest d1 score group.

Down-regulation of KOLT-2 antigen (CD28) by interleukin 2; role of IL-2R (p70)

Using KOLT-2 monoclonal antibody (mAb) recognizing a 44,000 molecular weight (MW) T-cell activation antigen (CD28), we observed the co-expression of KOLT-2 (CD28) antigen and Tac (CD25) antigen, associated with a 55,000 MW chain of the interleukin-2 receptor (IL-2R) complex. IL-2R (p55), on several T-cell lines transformed by human T-lymphotropic virus-I (HTLV-I), as well as several subclones of the natural killer (NK)-like cell line YT. When YT cells (YTC3T, YT5.1) and IL-2-dependent HTLV-I+ T-cell line cells (ED, ATL35C) expressing both IL-2R (p55) and IL-2R (p70) chains were cultured with recombinant IL-2 (rIL-2), KOLT-2 antigen was down-regulated in 24 hr. However, KOLT-2 antigen on HPB-ALL (Kurume) cells expressing neither of the IL-2R chains was unaffected by IL-2. IL-2 also failed to down-regulate KOLT-2 antigen on MT-1 cells bearing IL-2R (p55)/Tac without IL-2R (p70). To clarify the role of IL-2R (p70) in the IL-2-induced down-regulation of KOLT-2 antigen, we analysed the effect of IL-2 on a Tac- subclone of YT (YT2C2) that expresses IL-2R (p70). As was the case with Tac+ YT cells, KOLT-2 antigen was down-regulated by IL-2, and this down-regulation was inhibited by anti-IL-2R (p70) mAb but not by anti-Tac mAb. These results show that the signalling through the IL-2/IL-2R system down-regulates KOLT-2 (CD28) antigen by way of the interaction between IL-2 and IL-2R (p70), irrespective of IL-2R (p55)/Tac. Possible involvement of the IL-2/IL-2R system in the CD28-mediated mitogenic mechanism is discussed.

[Correlation of CT and pathologic findings of pulmonary lymphangioleiomyomatosis]

The X-ray CT findings of two cases of pulmonary lymphangioleiomyomatosis were reported. The correlation between high-resolution CT findings and inflated biopsy specimens was studied. The X-ray CT findings are 1) multiple low attenuation areas, 2) diffuse areas of slightly increased density and 3) irregular enlargement of pulmonary vascular images. Each low attenuation are turned out to correspond to emphysematous lesions. Slightly increased densities on CT images seemed to be caused by a summation of many small nodules of a proliferation of smooth muscle cells located in the wall of respiratory bronchioles and alveolar ducts, with or without intraalveolar hemosiderosis. Some nodular lesions in bronchiolar walls were so close to neighboring vessels that they could not be separated from vascular images on CT, so peripheral vascular images were irregularly thickened. X-ray CT reflected more actual pathological findings than routine chest radiographs. As low attenuation areas on CT images have been reported to be representative of pulmonary emphysema, it is thought that the above CT findings must be differentiated from those of pulmonary emphysema. While pulmonary vascular images were thin and stretched on the CT in patients with emphysema, they were irregularly thickened on the CT of patients with LAM. Furthermore, while CT of emphysema often revealed overinflation or decreased density, diffuse areas of slightly increased density were never found in emphysema.

Amyloidosis (AA type) with gastrointestinal involvement: resolution of gastric amyloid deposition in parallel with disappearance of the serum component of amyloid A protein

The prognosis for secondary amyloidosis is better than that for the primary form. With arrest of the triggering disease, clinical improvement can be expected. Dramatic resolution of amyloid deposits, as proven by repeated biopsies, has been reported. We report on the effectiveness of amputation of the left thigh with chronic osteomyelitis in a patient with AA amyloidosis presenting with extensive amyloid involvement of the gastrointestinal tract and kidneys. Clinical improvement associated with reversibility of gastric amyloid deposition was observed in accordance with disappearance of the serum component of amyloid A protein.

[Inhibitory effect of amlexanox (AA-673) on the immunological and non-immunological release of histamine or leukotrienes]

The effect of amlexanox on the non-immunological or immunological release of histamine or leukotrienes (LTs) from passively sensitized human lung fragments and atopic human leukocytes was investigated and compared with those of AA-861, tranilast, azelastine and disodium cromoglycate. 1) Amlexanox at concentrations of 10(-7)-10(-4) M showed an inhibition of histamine, LTB4, LTC4, LTD4 and LTE4 release from passively sensitized human lung fragments in a concentration-dependent fashion. A selective and competitive inhibitor of the 5-lipoxygenase activity, AA-861 modestly affected the histamine release and potently suppressed the any LT release at 10(-7) and 10(-6) M. Antiallergic drugs, tranilast and disodium cromoglycate also suppressed these chemical mediator release, but the inhibition potency was somewhat weaker than that of amlexanox. 2) Ca ionophore A23187-induced release of LTB4 and LTC4 from atopic human leukocytes was slightly enhanced up to 10(-6) M of amlexanox. However, 10(-4) M of the drug strongly diminished both of LT release. From these results, it is suggested that amlexanox is a clinically effective drug for atopic diseases, especially allergic asthma and rhinitis.

Indications, complications, and short-term clinical outcome of percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy was performed in 106 consecutive patients. Significant symptomatic improvement was achieved in 97 patients (92%). Mean left atrial pressure decreased (from 18 +/- 8 to 11 +/- 8 mm Hg, p less than 0.00001), mean mitral diastolic pressure gradient decreased (from 12 +/- 7 to 7 +/- 6 mm Hg, p less than 0.00001), and mitral valve area increased (from 1.40 +/- 0.40 to 2.00 +/- 0.50 cm2, p less than 0.00001). Based on echocardiographic characteristics of the mitral apparatus, patients were grouped retrospectively in three categories: pliable (group 1, n = 37), semipliable (group 2, n = 59), and rigid (group 3, n = 10). Clinical success was achieved in 36 patients of group 1 (97%) and in 55 patients of group 2 (93%). Only six patients in group 3 (60%) improved symptomatically (p less than 0.001 vs. group 1, p less than 0.001 vs. group 2). The severity of mitral regurgitation increased in five patients of group 1 (14%), in 12 of group 2 (20%), and in three of group 3 (33%). Six patients had recurrent symptoms at 9 months after commissurotomy. Recurrence of symptoms was significantly more frequent in group 3 compared with the other two groups (group 1, 3%; group 2, 4%; and group 3, 50%; p less than 0.0001 vs. groups 1 and 2). Multiple regression analysis identified the previously mentioned echocardiographic characteristics of the mitral apparatus as the significant predictor for clinical outcome. Thus, percutaneous transvenous mitral commissurotomy can be considered a safe and effective treatment for patients with pliable valves. Patients with semipliable or with rigid valves should be selected for operation very carefully.

[Nd-YAG laser therapy in the field of pulmonary surgery]

Since 1980, we have treated 71 patients with malignant tumors and benign lesions by the Nd-YAG laser. The flexible fiberoptic bronchoscope with the local anesthesia was used for the treatments. Fifty-four cases were malignant tumors and 17 were benign lesions involving trachea and/or hilar bronchus. In malignant tumors, 41 cases were lung cancers, 24 of which were squamous cell carcinomas. Of 17 cases of benign lesions, 10 (58.5%) were introgenic stenoses. Palliative treatments were done for 36 cases of lung cancers, of which 23 died within 1 year after treatments. Four of 5 cases, which survived beyond 2 years, were adenoid cystic carcinomas. In 17 benign cases, 13 (76.5%) showed distinct improvements of symptoms and findings after treatments. Three patients died of massive bleedings. In these cases, severe stenoses were observed, which required treatments repeatedly. With the proper knowledge of the indications, limitations and complications, of YAG laser therapy it can be a beneficial mean for the management of benign lesions and malignant tumors in trachea and hilar bronchus.

A case of amyloidosis associated with diphenylhydantoin therapy

Prolonged administration of diphenylhydantoin (DPH) has been implicated as a possible etiologic factor in immunological aberrations and lymphoproliferative disorders. Diphenylhydantoin may account for the increase in susceptibility to lymphoproliferative diseases, as a result of its immunosuppressive effect. We report a case of amyloidosis with monoclonal gammopathy which developed during DPH treatment, without multiple myeloma or lymphoproliferative disorders. The association between DPH and monoclonal gammopathy is very rare, and such a case of amyloidosis associated with DPH has not been reported previously. DPH, however, may have played a role in the development of monoclonal gammopathy, which was the precursor of amyloid protein.

[Surgical treatment of small cell lung cancer]

Thirty-four small cell lung cancer (SCLC) patients underwent surgery in Kyoto University from 1976 to 1989. The mean age was 62 years males numbered 25 cases, and females 9. All cases were LD except 2 rib-metastasized patients. Seventeen patients were in PS 0, and 17 in PS 1. Twenty-eight patients were treated with chemotherapy. In the remaining 5 patients 2 were treated by only oral 5-FU derivatives, one died upon operation, one was unable to be treated because of advanced age, and the last one refused chemotherapy. Except for the one operational death, 33 cases were able to be evaluated. Out of 28 patients, 16 were treated only by post-operative chemotherapy. As for operational radicality, 21 out of 31 cases were operated radically (68%). The survival rate of these 33 patients reached 78% for 1 year, 37% for and 5 years, with MSI at 26 months. The neoadjuvant (+) group showed a better prognosis than the non-non-neoadjuvant group.

Synthesis and antiallergic activity of N-[4-(4-diphenylmethyl-1-piperazinyl)butyl]-1,4-dihydro-4-oxopyridine-3 - carboxamides

A new series of oxopyridinecarboxamide derivatives 3a--g and 5a were synthesized and evaluated for their antiallergic activity. 1,4-Dihydro-7-methyl-4-oxo-1,8-naphthyridine-3-carboxamides 3a and 5a exhibited potent antiallergic activity (inhibitory rates of 80.7 and 88.3%, respectively, at 20 mg/kg, p.o.) in the rat passive cutaneous anaphylaxis (PCA) test and also exhibited much more potent in vitro inhibitory activity than caffeic acid against the enzyme 5-lipoxygenase (5-LO). Their in vitro antihistamine activity, however, was weaker than that of ketotifen. Compounds 3a and 5a are viewed as promising candidates for antiallergic agents.

Acrylamide derivatives as antiallergic agents. III. Synthesis and structure-activity relationships of N-[4-(4-diphenylmethyl-1-piperazinyl)butyl]- and N-[4-(4-diphenylmethylene-1-piperidyl)butyl]-3-heteroarylacry lamides

A new series of 3-heteroarylacrylamides 2 and 4 was prepared and the inhibitory activities against the rat passive cutaneous anaphylaxis (PCA) reaction and the enzyme 5-lipoxygenase (5-LO) were tested. Most of the compounds exhibited an anti-PCA activity superior to or equivalent to ketotifen and had a 5-LO inhibitory activity. The 3-heteroarylacrylamide derivatives including 3-(3-pyridyl)acrylamides represent a new structural class of compound that exhibits not only an in vivo anti-PCA activity but also an in vitro 5-LO inhibitory activity.

Acrylamide derivatives as antiallergic agents. 2. Synthesis and structure-activity relationships of N-[4-[4-(diphenylmethyl)-1-piperazinyl]butyl]-3-(3-pyridyl)acryl amides

A new series of 3-(3-pyridyl)acrylamides 16, 17, 19, and 26, and 5-(3-pyridyl)-2,4-pentadienamides 20-25 were prepared and evaluated for their antiallergic activity. Several of these compounds exhibited more potent inhibitory activities than the parent compound 1a [(E)-N-[4-[4-(diphenylmethyl)-1-piperazinyl]butyl]-3- (3-pyridyl)acrylamide] against the rat passive cutaneous anaphylaxis (PCA) reaction and the enzyme 5-lipoxygenase. Particularly, (E)-N-[4-[4-(diphenylmethyl)-1-piperazinyl]butyl]-3- (6-methyl-3-pyridyl)acrylamide (17p) showed an ED50 value of 3.3 mg/kg po in the rat PCA test, which was one-fifth of ketotifen and oxatomide. As compared with ketotifen and oxatomide, compound 17p (AL-3264) possessed a better balance of antiallergic properties due to inhibition of chemical mediator release, inhibition of 5-lipoxygenase, and antagonism of histamine.

Mitogenicity and down-regulation of high-affinity interleukin 2 receptor by YTA-1 and YTA-2, monoclonal antibodies that recognize 75-kDa molecules on human large granular lymphocytes

A large number of interleukin 2 receptors lacking the Tac epitope (IL-2R/p75) were found to be constitutively expressed on the human large granular lymphocyte/natural killer cell line YT, which bears inducible IL-2R/p55 associated with Tac antigen. Two anti-YT IgG1 monoclonal antibodies, YTA-1 and YTA-2, recognizing different epitopes of the same 75- to 80-kDa molecule, were established. The 75-kDa antigen recognized by these monoclonal antibodies was strongly expressed on the large granular lymphocytes of normal peripheral blood mononuclear cells and on various lymphoid cell lines bearing IL-2R/p75. The YTA-1 and YTA-2 antibodies were mitogenic and were different from other mitogenic monoclonal antibodies such as anti-T3 (CD3), anti-T11 (CD2), and KOLT-2 (CD28). Further, they down-regulated the high-affinity IL-2R of peripheral blood mononuclear cells within 24 hr in culture. The relationship between the YTA-1/2 antigen and the IL-2R system is discussed.

[Adjuvant surgery for lung cancer]

Recently several trials of adjuvant surgery or so-called neo-adjuvant chemotherapy have been reported about lung cancer. The indication of this therapy contains not only small cell lung cancers but also non-small cell lung cancers in most recent report. However, the therapeutic outcome is not satisfactory especially in N2 cases, better local control and, even a few, long time survivors were reported with this therapy. In our own experience of 10 cases since 1981, same tendency was recognized. So several type of controlled studies are necessary for the evaluation of adjuvant surgery to lung cancer.

Acrylamide derivatives as antiallergic agents. I. Synthesis and structure-activity relationships of N-[(4-substituted 1-piperazinyl)alkyl]-3-(aryl and heteroaryl)acrylamides

A new series of acrylamide derivatives (7-10) were synthesized. Antiallergic activity of these compounds was evaluated and their structure-activity relationships were examined. Compound 10d, N-[4-(4-diphenylmethyl-1-piperazinyl)butyl]-3-(3-pyridyl)acrylamid e, showed antiallergic activity equivalent or superior to that of ketotifen in the rat passive cutaneous anaphylaxis (PCA) test by oral administration. Compound 10d, unlike ketotifen, had more potent in vitro 5-lipoxygenase inhibitory activity than caffeic acid, whereas its in vitro antihistamine activity was weaker than that of ketotifen. In addition, its inhibitory activity against histamine release from rat mast cells was approximately two-thirds as potent as that of disodium cromoglycate (DSCG). Compound 10d is a promising agent for treating a variety of allergic diseases.

Changes in blood pressure and plasma norepinephrine during sleep in essential hypertension

A fall in blood pressure (BP) and the presence of a period of unstable BP during sleep has been reported in humans. However the mechanisms responsible for these phenomena are unclear. In order to examine the role of the sympathetic nervous system in these phenomena, plasma norepinephrine (PNE) was measured in patients with essential hypertension. Blood pressure was monitored under unrestricted conditions by a canula inserted into the brachial artery. During sleep, systolic (SBP) and diastolic blood pressure (DBP) fell by 18.8/13.7 mmHg, respectively. The magnitude of the fall in SBP correlated significantly (p less than 0.05) with the level of PNE in the daytime and with the magnitude of the fall in PNE during sleep. The period of unstable BP and pulse rate was observed during sleep. During this unstable period, BP changed periodically with 20 to 120-second cycles associated with parallel changes in pulse rate. PNE during this period was higher (p less than 0.05) than that during the period of stable BP during sleep. These data suggest that the sympathetic nervous system may play an important role in the fall in BP and unstability of BP during sleep.

Clearance and tissue distribution of functionalized polymeric liposomes from the blood stream of rats

Polymeric liposomes containing a synthetic porphinato-iron-imidazole complex (hemoglobin or red blood cell model) were labeled by introducing 1,2-di[1-14C]palmitoyl-sn-glycero-3-phosphocholine into their polymerized bilayers. After intravenous injection into rats, their clearance from a blood stream was measured. The apparent half-life time (50% disappearance time) was about 14 +/- 2 h. Their tissue distribution was determined with time by whole autoradiographic measurement.

Existence of renal alpha 1- and alpha 2-adrenoceptors in the human kidney: radioligand binding study in membranes from the human renal cortex and medulla

We investigated alpha 1- and alpha 2-adrenoceptors by radioligand binding studies in plasma membranes from the human renal cortex and medulla using a new alpha 1-adrenoceptor antagonist, 3H-bunazosin, and an alpha 2-adrenoceptor antagonist, 3H-rauwolscine. Human kidneys were obtained post-mortem (n = 4) or at surgery for carcinoma of the kidney (n = 10). The specific binding of both radioligands was rapid, saturable, reversible and specific. Scatchard analysis of 3H-bunazosin binding showed that the renal cortex had a KD of 4.6 nmol/l and a Bmax of 34.7 fmol/mg of protein, and the medulla a KD of 2.4 nmol/l and a Bmax of 23.2 fmol/mg. The specific binding of 3H-rauwolscine had a KD of 5.6 nmol/l and Bmax of 22.4 fmol/mg of protein for the cortex and values of 5.1 and 42.0, respectively, for the medulla. Competitive inhibition studies suggested that the binding of both radioligands was to sites with alpha 1 and alpha 2 specificity, respectively. The present studies demonstrate that human renal plasma membranes from both the cortex and medulla contain binding sites with both alpha 1- and alpha 2-adrenoceptors.

Prostaglandin E2 production by human bone marrow cells: a comparison with peripheral blood mononuclear cells

The amount of prostaglandin E2 (PGE2) in the supernatant of human bone marrow cell cultures was measured by radioimmunoassay. Bone marrow cells were obtained from adult patients without hematological malignancies. Marrow mononuclear cells (BMMNC) (0.5 X 10(6)) and marrow nonadherent cells (BMNAC) (0.5 X 10(6)) were cultured at 37 degrees C in 5% CO2 in 0.5 ml RPMI 1640 supplemented with L-glutamine, 10% fetal calf serum and 10 mM Hepes buffer. The levels of PGE2 in the supernatant of BMMNC after 24 hr and 48 hr incubation were 3,000 +/- 2,320 pg/ml (n = 10, mean +/- S.D.) and 4,470 +/- 3,510 pg/ml (n = 12), respectively. The kinetics of PGE2 production by BMMNC was different from that of peripheral blood mononuclear cells. The level of PGE2 in the supernatant of BMNAC after 48 hr incubation was only 1/18 when compared to that of BMMNC. These data suggest that the major source of PGE2 in the supernatant of marrow cell cultures may be bone marrow mononuclear phagocytes and that admixed blood mononuclear cells in BMMNC may produce only a small amount of PGE2.

[Intraoperative dual-mode independent lung ventilation for open-chest surgery: conventional volume-set ventilation in healthy lung and high frequency jet ventilation in diseased lung]

An effort by the anesthesiologist to maintain adequate ventilation during thoracic surgery is sometimes disturbing for the operative procedures of the surgeon. Unilateral ventilation with a large tidal volume, leaving the operative site unventilated, may provide an adequate and quiet operative field, but is opposed by the problem of disturbance in pulmonary gas exchange. The application of high frequency jet ventilation has recently been introduced to solve these problems. However, the disadvantage inherent to this technique is the tendency to produce carbon dioxide retention although it provides adequate oxygenation. In the present study, using a double lumen endobronchial tube, the large-tidal volume ventilation of the non-operative site and the high frequency jet ventilation with small tidal volume of the operative site were performed simultaneously. This technique provided the satisfactory condition of operative field, i.e., "quiet lung". Also, the serial gas analysis of the arterial and mixed venous blood samples indicated the satisfactory condition of pulmonary gas exchange.

[Protective effects of coenzyme Q10 on the adverse reactions of anthracycline antibiotics: using double blind method--with special reference to hair loss]

It was clinically evaluated by double blind method whether co-enzyme Q10 has protective effects on hair loss caused by anthracycline antibiotics. Six cases of acute leukemia, 2 blastic crisis of CML and 11 malignant lymphoma were entered to this study. DCMP regimen for acute leukemia for VEPA for lymphoma were performed. Coenzyme Q10 (or placebo) of 120 mg/day was orally administered. The grade of hair loss was classified into five groups. Five cases were only given to DM and 3 cases receiving DM and CoQ10. ADM was 6 cases and 5 were combined with CoQ10. No significant diffehence in effect of CoQ10 administration rence was recognized between two groups statistically. Elevations of GOT and GPT were less frequent in the group receiving CoQ10.