Pediatric and MCH training in Japan: JICA training program in the National Children's Hospital

The experience of the training program for overseas doctors in the National Children's Hospital during 8 years is described. The program was supported by the Japan International Cooperation Agency (JICA) and the objectives of the training course are to provide doctors from developing countries with a better understanding of diagnosis and treatment as specialized pediatricians and pediatric surgeons and to introduce recent medical techniques and equipment for child care. From 1984 to 1993, 37 doctors from 22 developing countries of Asia, Middle and South America and Africa have attended this program. There were 22 pediatricians, 14 pediatric surgeons and one dentist. The outline of this group training program and problems with the course are discussed.

Stereoselective analysis of the disposition of tosufloxacin enantiomers in man

The pharmacokinetics of tosufloxacin enantiomers after oral administration of racemic tosufloxacin were examined in healthy volunteers. Only small differences were observed in time to peak concentration (2.6 +/- 0.3 [mean +/- SEM] h for (+)-tosulfoxacin vs 2.4 +/- 0.2 h for (-)-tosufloxacin), elimination half-life (3.61 +/- 0.24 h vs 3.49 +/- 0.23 h), and area under the curve (2.78 +/- 0.19 h.micrograms/ml vs 2.87 +/- 0.19 h.micrograms/ml); however, peak concentration (0.40 +/- 0.03 microgram/ml vs 0.44 +/- 0.03 microgram/ml), renal clearance (226 +/- 10 ml/min vs 202 +/- 10 ml/min), and urinary recovery (35.4 +/- 2.2% vs 32.4 +/- 1.9%) differed significantly between enantiomers.

[Results of combination chemotherapy with etoposide, ifosfamide, peplomycin for advanced prostatic cancer]

Between August, 1986 and August, 1992, 16 combination chemotherapies with etoposide (100 mg/body, day 1-5), ifosfamide (50 mg/kg, day 1, 3, 5), peplomycin (5 mg/body, day 1-5) were performed on 13 patients with endocrine therapy-relapsed advanced prostatic cancer. Seven trials were performed on 5 patients who received DESP (diethylstilbestrol diphosphate) (500 mg/body, day 1-5) with the chemotherapy. In 9 trials performed on 9 patients who did not receive DESP, there was no response case. In 7 trials with DESP, one trial had a partial response (PR) (14%) and 4 remained objectively stable (stable) (57%). As to adverse effects, myelosuppression was observed in all trials but there was no lethal toxicity. The one-year survival rate of these patients treated with the chemotherapy alone and combined DESP were both about 20%. Therefore we should find a more effective treatment for endocrine relapsed prostatic cancer.

[Excellent exposure for the mitral valve by means of dissection of the interatrial groove]

A technique to approach the mitral valve through a left atrial incision under dissecting the interatrial groove is described. The dissection of the interatrial groove makes the left atrial incision more anterior and medial. Therefore excellent mitral valve exposure was obtained. 40 of 61 mitral valvular procedures during past 1.5-year period were approached through this incision. We could achieve better exposure of the mitral valve than that of conventional atrial incision technique. This technique takes not so long time and rarely carries complications including dysarrhythmia and bleeding.

Inhibitory effects of procainamide and probenecid on renal excretion of sultopride enantiomers in rats

The effects of the coadministration of procainamide and probenecid on the pharmacokinetic behavior of sultopride, an antipsychotic agent, after intravenous administration were studied with rats. The areas under the concentration-time curve for and renal clearances of (+)-sultopride and (-)-sultopride, which exist as organic cations under physiological pH conditions, were significantly decreased (p < 0.01) by the coadministration of procainamide, an organic cation under physiological pH conditions. The renal clearance of (-)-sultopride was partially decreased (p < 0.05) by the coadministration of probenecid, an organic anion under physiological pH conditions. The results suggest that drug-drug interactions between organic cations and organic anions occur to a certain extent during the tubular secretion process in rats.

[Experimental infection of the cynomolgus monkey with Helicobacter pylori]

To better understand the pathogenesis of Helicobacter pylori (H. pylori) associated gastritis and to evaluate the effectiveness of potential therapies in ulcer healing, we established an experimental animal model of H. pylori infection. A strain of H. pylori was isolated from the stomach of a Cynomolgus monkey, cultured and used to inoculate as a group of H. pylori negative monkeys. H. pylori-induced changes in the gastric mucosa was monitored both endoscopically and by histological evaluation of mucosal biopsy. After inoculation, H. pylori was found to colonize the gastric mucosa of these primates and had induced gastritis. In a related experimental series, we developed an experimental acetic-acid induced ulcer in the stomach of these monkeys. These results suggest that the Cynomolgus monkey may be a useful model to study H. pylori infection.

Antigen-specific proliferative response of peritoneal exudate lymphocytes primed with antigen and bacterial lipopolysaccharide: the roles of Ia+ accessory cells and IL-2

In vitro antigen-specific proliferation was investigated in a lymphocyte population that had been taken from the peritoneal exudate cells (PEC) of C3H/HeN mice (Iak) primed in vivo with both bacterial lipopolysaccharide (LPS) and horse red blood cells (HRBC) and had been purified by passage through a nylon fiber column (Nfc). The proliferative response of the Nfc-passed lymphocytes primed with HRBC and LPS [T(HRBC+LPS) cells] depended on the dose of antigen in the cultures, and the response was higher than that of cells prepared from mice primed with HRBC alone [T(HRBC) cells]. No response was seen in the cells prepared from the LPS-primed mice [T(LPS) cells] or normal mice [T(N) cells]. The response of the T(HRBC) cells was abolished by previous treatment of the cells with anti-Iak antibody and complement (C), whereas the response of the T(HRBC+LPS) cells was retained after the same treatment, indicating that the Ia- T(HRBC+LPS) cells can proliferate in response to antigen in spite of Ia+ accessory cell-depletion. Supernatants from the cultures of Ia- T(HRBC+LPS) cells in the presence of HRBC showed abundant IL-2 activity, while those of Ia- T(HRBC) cells did not. The IL-2 should be produced by the L3T4 cell population in T(HRBC+LPS) cells in response to antigen, since the previous treatment of the cells with anti-L3T4 antibody and C abrogated the production.(ABSTRACT TRUNCATED AT 250 WORDS)

Structural characterization of the N-linked carbohydrate chains from mouse zona pellucida glycoproteins ZP2 and ZP3

N-linked oligosaccharides of mouse zona pellucida glycoproteins ZP2 and ZP3 were prepared as pyridylaminated derivatives. Anion-exchange HPLC revealed that 95% or more of them are acidic. About 80% of these acidic chains were neutralized by digestion with Arthrobacter ureafaciens sialidase and a small amount of sulfate was found in the residual acidic chains. The neutralized fractions (SN fractions) from ZP2 and ZP3 were similarly fractionated by size-fractionation HPLC into many peaks having different numbers of LacNAc in the non-reducing regions. The SN fractions from ZP2 were cleaved by endo-beta-galactosidase into the core and non-reducing regions. The tri- and tetra-antennary complex-type chains with a Fuc residue were predominant in the core region. On the other hand, four kinds of fragment containing the LacNAc sequence were obtained from the non-reducing region. Sialic acids were shown to be linked to the core fragments, as well as the non-reducing fragments. The N-linked oligosaccharides of ZP3 were suggested to have essentially the same structures as those of ZP2.

Frequency of reciprocal translocations and dicentrics induced in human blood lymphocytes by X-irradiation as determined by fluorescence in situ hybridization

This study was designed to test the scoring efficiency of reciprocal translocations and dicentrics induced by X-irradiation in vitro using the fluorescence in situ hybridization (FISH) technique. An excess was found in the frequencies of reciprocal translocations relative to those of dicentrics by measurement with FISH at the first cell division after irradiation (translocation:dicentric approximately 60:40). However, when the same metaphases were also evaluated sequentially by a conventional staining method, the ratio of about 50:50 was restored. This was due in part to misclassification of certain dicentrics as reciprocal translocations by the FISH technique.

Disposition of enantiomers of sultopride in a human, rats and rabbits

Pharmacokinetics of sultopride enantiomers was examined following a single dose in a human, rabbits and rats. Pharmacokinetic profiles were similar between (+)- and (-)-enantiomers of sultopride in human, whereas the serum concentrations of (-)-sultopride were slightly higher than those of (+)-sultopride after i.v. administration of 50 mg/kg of racemic sultopride to rats and rabbits.

Effects of bed rest on bone metabolism in patients with femoral neck fracture

The effect of continuous 1 week bed rest during traction on bone metabolism were studied in patients with femoral neck fracture. Bone demineralization was assessed by measuring serum calcium (Ca), phosphorus (P), and alkaline phosphatase (AlkP) before, during, and after 1 week-bed rest with skeletal traction. In addition, 24-hour urinary excretion of calcium and phosphorus were measured. Serum Ca did not change significantly before, during, and after bed rest, whereas serum P increased after 1 week bed rest and postoperatively remained significantly elevated. Serum AlkP did not increase with bed rest, but became elevated postoperatively. Urinary Ca excretion increased from 105.8 +/- 15.2 to 138.0 +/- 15.4 mg/24h after 1 week of bed rest, and remained elevated postoperatively. In contrast, urinary P excretion initially increased 495.1 +/- 65.0 to 610.8 +/- 87.7 mg/24h, and subsequently decreased to a level significantly less than the admission level. These results suggest that 1 week bed rest for the patients with femoral neck fracture resulted in bone atrophy and demineralization.

Co-activation of sternocleidomastoid muscles during maximum clenching

In an attempt to determine the degree of co-activation present in selected cervical muscles during clenching, we instructed 12 male subjects to produce four brief maximum voluntary contraction (MVC) efforts (clenching) in a position of maximum intercuspation. Surface EMG activity was recorded bilaterally from the masseter and sternocleidomastoid (SCM) muscles. The contraction level for the SCM during clenching was reported as a percentage of the SCM's maximum activity achieved during maximum neck flexion against resistance. All EMG signals for the masseter and SCM were converted to a true RMS voltage signal and digitized at a 100-Hz sampling rate. Mean peak EMG voltage levels were determined for the activity recorded during each brief MVC task. All subjects demonstrated co-activation of the SCM during strong abrupt clenching efforts. The mean levels (+/- S.D.) of SCM activity were 11.8 +/- 9.6% (right) and 14.2 +/- 9.4% (left) of the MVC capacity. Fifty percent of masseter activity was required to achieve 5% activity of the SCM bilaterally, and there was a progressive development of the SCM co-activation which paralleled the masseter activation.

Sternocleidomastoid muscle inhibition induced by trigeminal stimulation

Among numerous reports of anatomical and functional coupling between the trigeminal and cervical systems is the demonstration that the sternocleidomastoid (SCM) muscles may become activated along with the masseter muscles during forceful abrupt biting maneuvers. Whether the co-activated SCM is also inhibited by stimuli that produce masseter inhibition is not known. This study evaluated the SCM for the presence of inhibition during mechanically-elicited (chin or forehead tap) and electrically-elicited (anterior maxillary gingiva stimulation) inhibition of the masseter muscle in ten healthy men. Surface EMG data were recorded bilaterally from the masseter and SCM muscles. The data for each muscle were converted to ratios of the pre-stimulus maximum voluntary contraction activity for each subject and averaged across subjects. Means of these percentages were determined at several defined pre- and post-stimulus intervals. The results indicate that masseter inhibition was clearly elicited by the electrical and both forms of mechanical stimulation. SCM co-inhibition could be evoked by electrical and chin tap stimulation but not by forehead tap. The responses to these stimuli varied among subjects, from trial to trial, and within subjects depending on the experimental condition. The fact that it was possible for this co-inhibition to be evoked is presented as further indication of the functional coupling of the trigeminal and cervical systems.

[Extraction of infected pacemaker electrode using catheter and snare]

A 85-year-old man had undergone implantation of a transvenous pacemaker system in 1982. Nine years later the generator was explanted and he was underwent implantation of a new generator and electrode. After one year of the second operation, infection of the old electrode had been noted and it was not cured in spite of partial explantation of the infected electrode and appropriate antibiotic therapy. We decided to remove the infected electrode and succeeded in extraction using catheter and snare. The patient's recovery was uneventful. We suggest catheter and snare is useful for explantation of chronic transvenous pacemaker electrodes.

Characteristics of DNA and multiple rpoD homologs of Microcystis (Synechocystis) strains

The base compositions of DNAs from nine Microcystis strains, as determined by high-performance liquid chromatography, were 41 to 42 mol% G+C. Chromosomal DNAs derived from these strains were found to be extremely resistant to many restriction endonucleases, and a restriction analysis revealed the presence of a dam-like methylase or both dam- and dcm-like methylases in all of the strains examined. Genomic Southern hybridization in which a synthetic oligonucleotide probe (rpoD probe) was used showed that members of the genus Microcystis might have multiple rpoD homologs, and the hybridization signal patterns observed with the DNAs of Microcystis aeruginosa strains were different from each other.

Successful upper labial replantation after 17 hours of ischemia: case report

This report presents successful replantation of the upper lip after 17 hours of ischemia. In spite of successful venous anastomoses, the postoperative use of leeches was necessary because of severe congestion. However, sensory and functional recovery was excellent.

Serial change of gastric mucosa after challenging with Helicobacter pylori in the cynomolgus monkey

The aim of this study was to clarify the change of the gastric mucosa following inoculation with Helicobacter pylori (H. pylori). Two pairs of cynomolgus monkeys received either H. pylori of human origin (group A) or H. pylori of monkey origin (group B) by intragastric inoculation at a dose of 10(9) CFU. After inoculation, endoscopical observation and biopsies were done every 7 days for one month. The bacteria in the biopsy samples were cultured quantitatively. The content of intracellular PAS-AB positive substance was quantitatively analyzed with the image analyzing system. Results were as follows: 1) Before inoculation, the gastric mucosa was endoscopically normal and free from H. pylori. 2) The quantity of H. pylori varied from 0 to 10(3) CFU/0.1 g tissue in group A and from 10 to 10(6) CFU/0.1 g tissue in group B. 3) Severe erosion was seen in group B, while mild mucosal erythema and erosion were observed in group A. 4) There was a correlation between the quantity of H. pylori and histological activity (Rauws' gastritis score). 5) The PAS-AB positive substance in H. pylori-positive mucosa was less than that in H. pylori-negative mucosa. In conclusion, gastric mucosal changes of varying degrees were brought about after inoculation of H. pylori depending on the quantity of bacilli in the gastric tissue.

[A case of bronchial lipoma treated by Nd-YAG laser surgery]

A 59-year-old man was referred to our hospital with complaint of cough. On physical examination the patient was 159 cm tall and weighted 68 kg. Chest X-ray showed an infiltrative shadow in the left lower lung field. Bronchoscopic findings revealed a polypoid tumor with smooth surface, located at the lower part of the left main bronchus and occupying over two-thirds of the left basal bronchus. A hamartoma was suspected as the result of bronchial biopsy. Endoscopic Nd-YAG laser surgery was performed. The left basal bronchus was opened. Histologically the tumor consisted mainly of mature fat tissue with collagen fibers and was diagnosed as a bronchial lipoma. Bronchial lipoma arising from the submucosal tissue of a large bronchus, occurs mainly in obese and middle-aged men. It is a rare benign tumor of the lung and only 38 cases have been reported in Japan.

Clinical implication and prognostic significance of small lymphoma cells in the peripheral blood and bone marrow of B-cell non-Hodgkin's lymphomas

It seems possible that small lymphoma cells (SLC) may have a role even in aggressive B-cell non-Hodgkin's lymphoma (B-NHL) such as large-cell lymphoma. However, SLC are often difficult to distinguish morphologically from normal or reactive small lymphocytes. In this study, we used a flowcytometric technique (kappa-lambda imaging; KLI) for detection of SLC. Peripheral blood (PB) and bone marrow (BM) samples taken from 41 patients with surface immunoglobulin positive (sIg+) B-NHL were analysed. SLC were detected in about 90% (37/41) of the untreated patients when either PB or BM was analysed by KLI. The presence of SLC correlated well with disease activity. However, a few SLC were present even in the PB (16%) or BM (27%) of the 31 patients who achieved complete remission, indicating that minimal residual disease (MRD) was present. In some cases, the reappearance of SLC in the PB or BM preceded clinical relapse. Furthermore, the initial volume of SLC, particularly in the BM, tended to be related to the prognosis (P = .068). These results suggest that the detection of SLC by KLI may be helpful not only for the screening and clinical staging of sIg+ B-NHL, but also for monitoring disease activity and detecting MRD. Moreover, the volume of SLC in the BM may be a useful predictor of prognosis.

Hepatitis C virus antibody in patients with primary liver cancer (hepatocellular carcinoma, cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma) in Japan

BACKGROUND

In hepatocellular carcinoma (HCC), a high prevalence of hepatitis C virus antibody (anti-HCV) has been reported, indicating that it may be an important etiologic factor in the pathogenesis of HCC. In this study, the authors investigated the prevalence of anti-HCV in HCC patients, as well as the same prevalence in patients with cholangiocarcinoma (CC) and combined hepatocellular-cholangiocarcinoma (combined HCC-CC), to study the clinicopathologic features of anti-HCV-positive cases.

METHODS

The authors examined 141 patients with primary liver cancer who were pathologically diagnosed as having HCC (121 cases), CC (13 cases), or combined HCC-CC (7 cases). Hepatitis B surface antigen (HBsAg) and anti-HCV were measured in these patients.

RESULTS

Of 121 HCC cases, 85 (70.3%) were found to be anti-HCV positive, 16 (13.2%) were HBsAg positive, and 5 (4.1%) were both anti-HCV and HBsAg positive. In 13 cases with CC and in 7 with combined HCC-CC examined, 4 (30.8%) and 5 (71.4%), respectively, were anti-HCV positive.

CONCLUSIONS

The anti-HCV-positive rate was high in combined HCC-CC as well as in HCC. These three types of primary liver cancer, which were anti-HCV positive, shared two common features: male dominance and high incidences of complication with liver cirrhosis.

Chemiluminescence from bamboo shoot cut

Bamboo shoot cut emitted weak light, which could be visualized with a two dimensional imaging system. A water extract of bamboo shoot contained tyrosine (a major component of total amino acids), bityrosine and peroxidase. Bamboo shoot peroxidase-H2O2-tyrosine system also emitted weak light with maxima at 490nm, 530nm and longer wavelength, identical to that in horseradish peroxidase-H2O2 system. Judging from these results, chemiluminescence from bamboo shoot cut might be originated from excited species generated by enzymatic oxidation of tyrosine and bityrosine.

[Transdermal application of 10% lidocaine-gel for management of pain associated with herpes zoster]

We have developed transdermally applicable 10% lidocaine aqueous gel containing an absorption promoter and applied it for 15 patients suffering from severe pain in acute or subacute phase of herpes zoster. The patients, consisting of 7 males and 8 females with a mean age 58.5 +/- 13.0 (SD) yrs, had skin eruptions of herpes zoster for the past 2 months. Lidocaine-gel was applied locally to the diseased skin with or without an occlusive dressing. In 14 of the 15 patients (93%), a remarkable reduction of pain (below 10% of pretreatment level) was obtained after 9.9 +/- 5.6 (SD) times of lidocaine-gel treatments. There was no adverse systemic reactions or local skin damages. None of them developed post-herpetic neuralgia. The lidocaine-gel treatment appears to be very useful for reduction of pain associated with acute or subacute phase of herpes zoster.

Decreased production of active oxygen species by neutrophils in patients with liver cirrhosis and hepatocellular carcinoma

Adult respiratory distress syndrome (ARDS) following infection is one of the postoperative complications of hepatectomy of cirrhosis. In this study we focused on the anti-microbial activity of neutrophils. We measured production of active oxygen species by neutrophils, and simultaneously examined their nutritional status, immunity and ICG (K-ICG) disappearance ratio. When compared to the controls, the patients with cirrhosis had significantly lower production of O2- upon stimulation by N-formyl-Met-Leu-Phe (fMLP) or opsonic zymosan (OZ). The presence of cancer did not affect results for the groups studied. Overall H2O2 production was lower in cirrhotic patients than in controls. There was a positive correlation between O2- production and K-ICG, which was used to estimate the severity of cirrhosis. Indicators of nutrition and immunity were also lower in cirrhotic patients, but neither of these indicators correlated with the production of active oxygen species. From these results, we concluded that the production of active oxygen species by neutrophils is lower in cirrhotic patients than in controls. Moreover, this decline correlates with the severity of cirrhosis.

Pharmacokinetics of intravenous ataprost alfadex, a new prostaglandin I2 analog in healthy volunteers

Ataprost alfadex [5(E),-6,9-deoxa-6,9 alpha-methylene-15-cyclopentyl-16,17,18,19,20-pentanor- PGI2 alpha-cyclodextrin clathrate] is a novel PGI2 derivative. From animal studies, it is expected to be a more potent inhibitor of platelet aggregation and less hypotensive than PGI2. The pharmacokinetics of ataprost were studied in 9 healthy male volunteers during and after i.v. infusion for 2 hours at the rates of 2.5 (n = 5) and 10 ng/kg/min (n = 4). Both treatments were well tolerated by the subjects. At the end of the infusion, plasma levels of 191 +/- 76 (mean +/- SD) and 645 +/- 191 pg/ml were reached, declining rapidly with half-lives of 6.7 +/- 3.0 and 5.5 +/- 0.84 minutes at the lower and higher infusion rates, respectively. The area under the plasma concentration-time curve extrapolated to infinity increased with the dose as follows: 28.7 +/- 9.8 and 80.9 +/- 24.8 ng.min/ml. The unchanged drug was not detected in urine but a metabolite was recovered in it, reaching up to 6.0 +/- 0.85% of the total dose within the first 24 hours, the most part of which was recovered within the first 4 hours.

Non-specific resistance induced by a low-toxic lipid A analogue, DT-5461, in murine salmonellosis

The ability of DT-5461, a chemically synthetic low-toxic lipid A analogue, to activate anti-Salmonella activity in C3H/HeN mice was examined. Previous intraperitoneal (i.p.) injection of DT-5461 (100 micrograms or more/mouse) significantly hindered the bacterial growth in the peritoneal cavities of the mice after the i.p. infection with Salmonella typhimurium LT2 strain. The effect was the maximum when DT-5461 was given 6 h before the challenge. The injection of DT-5461 6 h in advance could also confer protection against the infection. Bactericidal activity enhancement was also seen in mice that had been injected with a small amount of recombinant murine IFN-gamma (10(3) U per mouse) and non-effective dose (10 micrograms) of DT-5461 together 6 h before the challenge. Bactericidal effect enhancement was seen in mice that had been injected with IFN-gamma at 6 h and DT-5461 at 3 h before the challenge, while it could be hardly seen in mice injected with them in a reversed order. The i.p. injection of DT-5461 recruits the exudate cells into the peritoneal cavities, and the phagocytic and bactericidal abilities of the macrophages in the exudate cells are apparently elevated. The mechanisms of non-specific resistance enhancement induced by DT-5461 were discussed.