Carotid arterial impedance during oscillated blood flow

Blood perfusion of systemic circulation is influenced by the physical characteristics of artery. Several investigations proposed that the physical parameters of vessels are determined by neurological factors, hormonal factors, and physical properties of arteries among others. In this study, arterial impedance was estimated because it may express the condition of vessels. To examine the change of arterial impedance according to the blood flow pattern, the typical sine wave blood flow (oscillated flow) was used during total cardiopulmonary bypass (CPB) because it is considered the most simple pulsatile flow. CPB using oscillated blood flow was performed in acute experiments on adult goats. Total systemic flow was controlled to remain at approximately 80 ml/min. Carotid arterial flow, aortic pressure, central venous pressure, and systemic flow were measured. Total peripheral resistance, carotid arterial resistance, systemic impedance, and carotid arterial impedance were calculated to evaluate blood flow distribution during CPB. This study suggested that the parameters of carotid arterial blood flow changed according to the change of flow frequency during oscillated blood flow. This change may occur because arterial impedance was influenced by flow frequency; therefore, the blood flow of the carotid artery was significantly changed according to the change of the frequency component of blood flow.

Role of eicosapentaenoic acid in lipid metabolism in the liver, with special reference to experimental fatty liver

Choline-deficient feed was given to three groups (n = 7 in each) of male Sprague-Dawley rats for 4 weeks to induce the development of fatty liver. In addition, two of the groups received eicosapentaenoic acid (EPA), 1000 mg/kg/d, administered orally either for all 4 weeks or for only the last 2 weeks of the study, respectively. The third group received the choline-deficient diet but no EPA. The untreated control group (n = 7) received only normal feed. The efficacy of EPA in preventing fatty liver was assessed based on the evaluation of pathologic and biochemical parameters and hepatic blood flow. EPA markedly improved fatty liver, probably due to both direct effects (inhibition of the synthesis of triglyceride in the liver) and indirect effects (increased hepatic blood flow). Decreased blood flow due to sinusoidal block is responsible for the progression of fatty liver. EPA has been shown to decrease thromboxane A2 production and blood viscosity and to enhance red cell deformability. These effects are thought to have contributed to the increases in hepatic blood flow.

[Vascular involvements in systemic lupus erythematosus]

It is an established fact that systemic vasculitis can occur during the course of SLE as well as other rheumatic diseases. The principal disorders of SLE are found to be associated with small arteries. However, clinical evidence of arterial disease in SLE patients varies considerably from patient to patient. Clinical manifestations of lupus vasculopathy including vasculitis and microangiopathy were described. Regarding systemic vascular lesions in SLE, the prognosis for the patients with thrombosis and vascular involvement of medium-sized arteries was the most grave. Treatments including steroids, immunosuppressants, plasmapheresis, anticoagulants, etc. are used according to causative factors which result in lupus vasculopathy.

[Postoperative delirium and abnormal behaviour related with preoperative quality of life in elderly patients]

Postoperative delirium and abnormal behavior were studied in 160 patients aged 60 and over with relation to their QOL assessed before surgical operation. QOL was assessed physically, psychologically, mentally and socially. Physical status was assessed with ability in daily life, seeing, hearing and severity of disease. Psychological condition (depression) was assessed by using GDS (Geriatric Depression Scale of Sheikh), Mentality (dementia) was assessed by using CDR (Clinical Dementia Rating) and HDS-R (Revised version of Hasegawa's dementia Scale). Sociality was assessed by social life and familial environment. Postoperatively 37.1% of males and 28.9% of females developed delirium and abnormal behaviour. Abnormal behaviour of demented patients was not defined as due to delirium or as dementia itself, so it was included in the classification "delirium and abnormal behaviour" because of the same aspect in terms of practical nursing care. The following factors were found to be statistically related to the occurrence of postoperative delirium and abnormal behaviour: disability in daily life, dementia, disturbance of hearing. Scores of HDS-R was closely related with the possibility of postoperative delirium and abnormal behaviour.

An immunohistochemical study of sebaceous carcinoma with anti-keratin monoclonal antibodies: comparison with other skin cancers

Formalin-fixed and paraffin-embedded tissue specimens of six cases of extraocular sebaceous carcinoma were studied immunohistochemically with eight anti-keratin monoclonal antibodies, 34 beta B4, 35 beta H11, Ks13.1, Ks19.1, PKK1, LP34, KL1 and AE1. The staining patterns of sebaceous carcinoma were compared with those of normal sebaceous glands and other skin cancers which should be distinguished from sebaceous carcinoma histopathologically. The other skin cancers compared were eccrine porocarcinoma, malignant clear cell hidradenoma, extramammary Paget's disease with underlying adenocarcinoma, malignant trichilemmoma, and squamous cell carcinoma. Most cases of sebaceous carcinoma were stained with 35 beta H11, Ks19.1, LP34, KL1 and AE1, while normal sebaceous glands were positive only with 35 beta H11, LP34, KL1 and AE1. By immunostaining, sebaceous carcinoma was distinguishable from extramammary Paget's disease with underlying adenocarcinoma, squamous cell carcinoma, malignant trichilemmoma, and eccrine porocarcinoma, but was not clearly distinguishable from malignant clear cell hidradenoma. These findings demonstrate that sebaceous carcinoma shows positive reactions with antibodies to simple epithelial keratin, probably as a result of neoplastic transformation, and that immunohistochemical examination using anti-keratin monoclonal antibodies is useful in distinguishing sebaceous carcinoma from several other skin cancers.

[A clinical study of total cystectomy for patients with bladder cancer]

We assessed the treatment outcome of total cystectomy for 67 patients with bladder cancer treated at Asahikawa Medical College Hospital between 1977 and 1991. The analyses of cause-specific 5-year survival rates by pathological stage (pT) and grade revealed a lower survival rate for higher stage, higher grade and non-transitional cell carcinomas. The condition of lymph node metastases (pN) was also correlated to the survival rate. Significant differences were observed between the survival rates of the patients with pT < or = 2 and pT > or = 3, and the patients with pNO and pN > or = 2. The cancer deaths were mainly caused by distant metastases. Preoperative irradiation showed prognostic advantage in the patients who had acquired down-staging by this treatment, and postoperative systemic chemotherapy also improved the prognosis in the patients with pT > or = 3.

Impaired interleukin-8-dependent chemotaxis by synovial fluid polymorphonuclear leukocytes in rheumatoid arthritis

The accumulation of polymorphonuclear leukocytes (PMN) in synovial fluid is a common feature of rheumatoid arthritis (RA). We studied the chemotactic response of PMN obtained from the synovial fluid and from the peripheral blood of patients with RA using a modified Boyden's method, in which interleukin-8 (IL-8) or N-formyl-methionyl-leucyl-phenylalanine (FMLP) was used as a chemotactic agent. The IL-8-induced response of peripheral blood PMN from 15 patients with RA did not differ from that of 15 healthy controls. A decreased chemotactic response to IL-8 was, however, observed in PMN from the synovial fluid of 12 patients with RA compared with peripheral blood cells of the same individual. This defective chemotactic ability of PMN was inversely correlated with the number of infiltrating cells in the synovial fluid. We also obtained similar results with FMLP. These results indicate that the chemotactic ability of PMN may be reduced after migrating to the synovial fluid.

[Malignant parasagittal meningioma appearing as a large subcutaneous mass]

We present a rare case of malignant meningioma appearing as an extracranial soft-tissue mass. A 34-year-old male was admitted with left parietal subcutaneous soft-tissue mass. Neurological examination on admission revealed right leg monoparesis and papilledema. Skull X rays showed hyperostosis of the left parietal bone. There was no evidence of bony destruction. CT and MRI showed a tumor with a large intracranial component, which was homogeneously enhanced. The tumor was totally removed by left ostoplastic craniotomy. The light-microscopic examination showed a meningothelial meningioma accompanied by malignant components with necrotic foci and mitotic figures. Tumor cells had invaded all the layers of the skull via the Haversian canals. We propose that hyperostosis with tumor invasion through all three layers of the skull should be considered as a malignant feature.

[Methylprednisolone pulse therapy for SLE patients with CNS disorder]

A clinical trial was conducted in 22 SLE patients with central nervous system (CNS) disorder in which the efficacy of pulse methylprednisolone suleptanate at the dose of 400 mg or 800 mg (as methylprednisolone) was assessed. The symptoms of CNS disorder disappeared within 40 days after pulse therapy in all of the 16 patients with organic brain syndrome (OBS). No improvement in the symptoms took place in any but one of the five patients who had cerebrovascular disorder. One SLE patient with depression showed improvement 55 days after pulse therapy. In the patients with OBS who had not received pulse therapy until 28 days or more after onset of CNS disorder, the symptoms disappeared in 20 days or more in both 400 mg and 800 mg dose groups. On the other hand, five of the six patients given the dose of 800 mg within 10 days of occurrence of the disease experienced a complete relief of the symptoms in 10 days after pulse therapy. However, at least 13 days were required for complete relief in all the four patients of the 400 mg group. The adverse reactions reported consisted of hyperlipemia, diabetes mellitus, and infections such as thrush or herpes zoster. The above results suggest that methylprednisolone pulse therapy is useful in the treatment of CNS disorder associated with SLE, particularly in patients with OBS who are given the dose of 800 mg early after onset of the disease.

Cerulenin-resistant mutants of Saccharomyces cerevisiae with an altered fatty acid synthase gene

Cerulenin, an antifungal antibiotic produced by Cephalosporium caerulens, is a potent inhibitor of fatty acid synthase in various organisms, including Saccharomyces cerevisiae. The antibiotic inhibits the enzyme by binding covalently to the active center cysteine of the condensing enzyme domain. We isolated 12 cerulenin-resistant mutants of S. cerevisiae following treatment with ethyl methanesulfonate. The mechanism of cerulenin resistance in one of the mutants, KNCR-1, was studied. Growth of the mutant was over 20 times more resistant to cerulenin than that of the wild-type strain. Tetrad analysis suggested that all mutants mapped at the same locus, FAS2, the gene encoding the alpha subunit of the fatty acid synthase. The isolated fatty acid synthase, purified from the mutant KNCR-1, was highly resistant to cerulenin. The cerulenin concentration causing 50% inhibition (IC50) of the enzyme activity was measured to be 400 microM, whereas the IC50 value was 15 microM for the enzyme isolated from the wild-type strain, indicating a 30-fold increase in resistance to cerulenin. The FAS2 gene was cloned from the mutant. Sequence replacement experiments suggested that an 0.8 kb EcoRV-HindIII fragment closely correlated with cerulenin resistance. Sequence analysis of this region revealed that the GGT codon encoding Gly-1257 of the FAS2 gene was altered to AGT in the mutant, resulting in the codon for Ser. Furthermore, a recombinant FAS2 gene, in which the 0.8 Kb EcoRV-HindIII fragment of the wild-type FAS2 gene was replaced with the same region from the mutant, when introduced into FAS2-defective S. cerevisiae complemented the FAS2 phenotype and showed cerulenin resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental study of the mechanism of seizure induction: changes in the concentrations of excitatory amino acids in the epileptic focus of the cat amygdaloid kindling model

L-glutamate (Glu) and L-aspartate (Asp) are two major excitatory amino acids that may be involved in seizure susceptibility and seizure induction. The concentrations of Glu and Asp were measured by microdialysis in the epileptic focus in a cat amygdaloid kindling model. Sequential changes in Glu and Asp (before, during, and after seizure) were measured in the partial seizure (S4) and generalized seizure (S6) groups. By stimulation at and 50 microA below the partial seizure-triggering threshold in the S4 group and the generalized seizure-triggering threshold in the S6 group, Glu was released from the epileptic focus in the S4 group, and both Glu and Asp were released in the S6 group after seizure and stimulation (below threshold), and the amount of Glu and/or Asp release determined seizure induction. Excitatory amino acids may be the trigger of seizure induction in the cat amygdaloid kindling model.

[A case of minocycline-induced pneumonitis with bronchial asthma]

We report a case of minocycline-induced pneumonitis. A 30-year-old woman was treated with minocycline for mycoplasma pneumonia of the right upper lobe. About 15 days after starting treatment, she developed a productive cough, stridor, and dyspnea. The chest X-ray film showed pulmonary infiltration in the left middle lung field. Based on the clinical history and the detection of eosinophilia in the bronchoalveolar fluid, drug-induced pneumonitis was suspected. Treatment with minocycline was discontinued and prednisolone (20 mg/day) was started, after which her symptoms subsided and there was marked regression of the pulmonary infiltrates on chest X-ray films. The lymphocyte stimulation test for minocycline was negative, but the diagnosis was confirmed by a positive oral provocation test.

Unique T cell differentiation markers: gangliosides with cholera toxin receptor activity on murine fetal thymocytes

Cholera toxin B subunit receptors (CTBR; gangliosides GM1a and GM1b-GalNAc-Gal) and GM1b-type gangliosides were examined during T cell development in BALB/c mice by FACS or TLC immunostaining. Sixty-two percent of CD4-8- early fetal thymocytes express CTBR [58% low affinity (GM1a+), 4% high affinity (GM1a2+)] at 13 days gestation (Day 13); GM1a2+ was expressed preferentially on Thy-1+ fetal thymocytes after Day 13. GM1a2+ Thy-1+ cells increased from 4% on Day 13 to 95% on Day 17. Surface GM1a2+ decreased beginning on Day 15 while GM1b-GalNAc-Gal (and CD4 and CD8) increased. GM1b-type+ cells increased from 8% on Day 13 to 51% on Day 17 and then decreased to 16% at 4 weeks; few asialo GM1+ cells (< 5%) are seen during gestation. Thus, synthesis of GM1a- and GM1b-type series was active until Days 15 and 17, respectively, and then was suppressed; GM1b-GalNAc-Gal was synthesized from GM1b following Gestational Day 15. GM1a- and GM1b-type identify immature T cells in mice, while GM1b-GalNAc-Gal identifies mature T cells.

[Effect of growth hormone on fetal and placental growth of spontaneous dwarf rat]

The effect of growth hormone on fetal and placental growth was studied in the spontaneous dwarf rat (SDR). The SDR is a newly established experimental model for pituitary growth hormone (GH) deficient dwarfism with an autosomal recessive mode of inheritance. The growth of heterogenic fetuses which were made by crossing female SDRs with normal male rats was similar to that of homogenic SDR fetuses on day 16 of gestation (Day 16), but on Day 20 heterogenic fetuses which had GH in their serum were significantly heavier than homogenic fetuses. There was no significant difference between the two groups in placental weight. The daily infusion of ovine-GH into pregnant SDR caused a significant increase in placental weight on Day 20, but had no effect on fetal growth. These results suggest that fetal GH plays a role in the fetal growth without affecting placental growth, and that maternal GH affects placental growth without affecting fetal growth.

Effects of imipramine and amitriptyline on intraventricular conduction, effective refractory period, incidence of ventricular arrhythmias induced by programmed stimulation, and on electrocardiogram after myocardial infarction in dog

The effects of imipramine and amitriptyline on intraventricular conduction, effective refractory period, incidence of ventricular arrhythmias induced by programmed stimulation and on electrocardiogram changes were studied after myocardial infarction in the dog. Amitriptyline, at doses of 1-3 mg/kg, significantly slowed the ventricular conduction of the infarcted zones in a dose- and frequency-dependent manner. Amitriptyline, at doses of 2 and 3 mg/kg, slowed the ventricular conduction slightly in the normal zone. The effective refractory period was prolonged by amitriptyline at a dose of 1 mg/kg. Amitriptyline increased the incidence of ventricular arrhythmias induced by programmed stimulation. Amitriptyline, at doses of 1-3 mg/kg, increased heart rate and prolonged the PQ, QRS and QT interval. Imipramine, at a dose of 3 mg/kg, slowed the conduction in infarcted zones to a lesser extent than amitriptyline. Imipramine, at doses of 1 and 2 mg/kg, did not significantly increase the incidence of ventricular arrhythmias. Imipramine, at a dose of 3 mg/kg, prolonged the QRS interval. From the present results it appears that imipramine has a lower cardiac toxicity than amitriptyline.

[Neuroleptanesthesia for a patient with mitochondrial encephalomyopathy]

This report describes a patient with mitochondrial encephalomyopathy who underwent an ophthalmic surgery under original neuroleptanesthesia. This 28-year-old female patient had been suffering from bilateral external ophthalmoplegia and blepharoptosis. Her preoperative neurological examination revealed a mitochondrial encephalomyopathy. Biopsy and blepharo-elevation for her left eyelid were scheduled. Anesthesia was induced with thiopental 5 mg.kg-1 and vecuronium 0.07 mg.kg-1, and maintained with total doses of 10 mg of droperidol, 400 micrograms of fentanyl and 4 mg of vecuronium. The patient recovered from anesthesia smoothly and her postoperative course was uneventful. Anesthetic management of patients with this disease and possible complications were discussed.

[Prognostic factors influencing survival after operations for gastric cancer in the elderly]

The prognostic factors influencing survival after operations for gastric cancer in the elderly were evaluated by Cox's proportional hazards model analysis. Data were obtained from 511 operations over a 10-year period, in patients with a mean age of 75.6 +/- 7.9 years. The significant prognostic factors of survival out of 47 examined risk factors were, in order of standardized coefficient values, (1) stage of cancer, (2) %IBW, (3) peritoneal dissemination (P-factor), (4) multiple non-gastric cancers, (5) postoperative hepatic injury and (6) postoperative cardiac complication. No other factors, including preoperative associated diseases and postoperative pulmonary complication (the major risk factor of operative death), were significant risk factors of survival. We conclude that by giving special postoperative attention to prevent hepatic injury and cardiac complication, the length of survival of elderly patients with gastric cancer will improve.

[A survey of Staphylococcus aureus for typing and drug-resistance in various areas of Japan during 1992 and 1993]

Data on Staphylococcus aureus strains isolated at various areas in Japan during 1992 and 1993 were collected and analysed. Among 7,033 strains examined, 60.3% were methicillin-resistant S. aureus (MRSA), 86% of which were isolated from inpatients. MRSA were isolated most often (38%) from departments of internal medicine, followed by departments of surgery (13%). The most frequent source of MRSA was sputa (38%), followed by pus (18%). As for coagulase types, 69% of MRSA were Type II and next most frequent was Type VII (24%). Among MSSA strains, Type VII (35%) and Type III (32%) were the most frequent. Frequencies of beta-lactamase-producing strains were 68% in MRSA and 59% in MSSA. More than 80% of MRSA strains were resistant to beta-lactams. The frequencies of resistance to fosfomycin, ofloxacin, minocycline and gentamicin were 88%, 72%, 19% and 66%, respectively. Less than 3% of MRSA strains were resistant to arbekacin or vancomycin.

[Nationwide investigation in Japan of the status of MRSA infections and usefulness of arbekacin]

A clinical investigation on MRSA infections, and the determination of the efficacy and usefulness of arbekacin (ABK) were performed an "MRSA Forum" composed of 18 groups including 115 institutions in Japan. Patients with infectious diseases clearly related with MRSA, a total of 348 (males: 237, females: 111), were evaluated, 74/274 patients were treated with ABK alone/combination with ABK. Most of them (94.6%/96.4%) had underlying diseases and they had pneumonia (38/175), sepsis (6/35) or other infections (30/64). Infections by MRSA alone were noted in 41/159 and polymicrobial infections including with MRSA were in 33/115. 53.6%/56.4% of MRSA were eradicated and bacteriological clinical efficacies were 75.6%/67.9% in single infections and 63.6%/71.3% in polymicrobial infections. The clinical efficacies were obtained in 70.3%/69.3% of total and in 60.5%/72.0% of pneumonia and in 90.0%/80.8% of the patients pretreated with other drugs within 3 days previously. Efficacy rates were 78.6%/71.4% in 30 minute's div and 63.2%/66.4% in 60 minute's div. Adverse effects were found in 4.76%/5.70% including renal function disorder (2/11) but no case was serious. Abnormal laboratory test results were noted in 15.4%. ABK is effective against MRSA infections.

[Questionnaires regarding MRSA in Japan]

Changes in properties of MRSA and the status of MRSA infections in the last two years were investigated by an MRSA Forum composed of 18 groups including 115 medical institutions in Japan. And an opinion poll regarding MRSA was taken by professional doctors (41) and general clinical doctors (323). Points of discussion: 1. Did properties of MRSA change? 2. Did the pattern of MRSA infections change? 3. Did the understanding of MRSA change? 4. What is the relationship between MRSA and the 3rd cephems? 5. How is MRSA related to polymicrobial infections? 6. Is ABK useful against MRSA infections? 7. What will be future trend in characteristics of MRSA and MRSA infections?

CONCLUSIONS

1. MRSA has become more resistant to methicillin however it seemed to have become less toxic. 2. Severe MRSA infections are decreasing and colonizations are increasing. 3. There were some differences in attitude against MRSA between professional doctors and general clinical doctors. 4. The 3rd cephem should be used reasonably. 5. MRSA infections should be treated with polymicrobial infections in consideration. 6. MRSA did not gain resistance against ABK and ABK is useful against MRSA infections. 7. Problems of MRSA will cool down but they should always be kept in our mind.

[Drug resistance of methicillin-resistant Staphylococcus aureus (MRSA) in Japan until 1993]

Isolation frequency of MRSA in Japan increased up to 60% until 1993. The therapy of infectious diseases usually begins empirically, then doctors would verify or change their regimen according to laboratory data. But the hospital-infected MRSA strains are now highly resistant to beta-lactams, and strains resistant to other antibiotics such as, macrolides, quinolones and minocycline are also increasing. MRSA strains in infected focus are often mixtures of strains expressing different patterns of multiple resistance, and often exist with other pathogens such as Pseudomonas aeruginosa. Relying upon laboratory data alone, often results in emergence of new resistant bacteria or replacement of pathogens, hence ineffectiveness of chemotherapy. Now only arbekacin and vancomycin are the antibiotics to which resistant strains are less than 3%. Other antibiotics should be used after considering the resistance pattern of isolates from the patient and in the hospital. Most of the MRSA-infected patients are compromised hosts, and the in vivo efficacy does not always reflect the in vitro results. Even arbekacin and vancomycin are sometimes recommended to be used in combination therapies with other drugs.

[Double blind trial of pulse methylprednisolone versus conventional oral prednisolone in lupus nephritis]

A double blinded clinical trial was conducted in which the efficacy and safety of pulse methylprednisolone (400 mg/day) was compared with oral prednisolone (50 mg/day), a control drug for a period of 3 months. One-hundred and two (102) patients were enrolled in the study, of which 91 patients were determined as eligible for analysis of efficacy. Patients on pulse methylprednisolone had more favorable response to therapy with regard to laboratory value changes from baseline such as CH50 and anti-DNA antibody titers. In terms of anti-DNA antibodies, a significant difference was detected at one week after treatment. With regard to time course changes in laboratory values, CH50 at one and two weeks after treatment showed a significantly higher elevation in the pulse methylprednisolone group than in the control group. There was no significant difference noted in incidence of adverse reactions between both treatment groups. No serious adverse reaction was encountered in the pulse methylprednisolone group. The physician's assessment of final global improvement significantly favored the pulse methylprednisolone-treated group. The above results suggest that the pulse therapy with methylprednisolone leads to more rapid onset of drug effect than the conventional oral prednisolone in the treatment of lupus nephritis.