[Effectiveness of low dose continuous infusion of alpha-hANP from the start of cardiopulmonary bypass]

In this study, we used alpha-human atrial natriuretic peptide (hANP) from staring on cardiopulmonary bypass and evaluated for the hemodynamics, ANP, renin activity, aldosterone, urine volume, glomerular filtration rate (GFR) and so on. The hANP decreased renin activity, aldosterone, systemic vascular resistance and increased urine volume, GFR and use of furosemide and KCL were decreased. We concluded that hANP was effective for hemodynamics, renal function and hormonal release on intra and post-operation in cardiac surgery, and low dose continuous infusion of alpha-hANP from staring on cardiopulmonary bypass will be expected as a newly application.

[Progress in oral anti-cancer drug therapy for urological cancer]

We describe the progress in oral anti-cancer drug therapy for urological cancer. Pure antiandrogen (e.g., flutamide) is widely used as a means of maximal androgen blockade (MAB) in the treatment of prostate cancer. However, all series reported in the past several years did not show positive effects on prolongation of the patient's survival. Evaluations by meta-analysis are in progress. As the mechanism of antiandrogen withdrawal syndrome has been recognized, it was widely accepted that antiandrogen should be discontinued when disease progression or PSA elevation becomes evident. Estramustine was recently clarified as an effective therapeutic agent in the treatment of hormone refractory prostate cancer in combination with oral etoposide. Oral etoposide therapy has been tried as a maintenance or a palliative chemotherapy for non-curative or high-risk germ cell tumor. UFT (a compound of tegafur and uracil) is said to be effective for bladder cancer. It has been also suggested that UFT was partly effective as a means of first-line endocrine chemotherapy for advanced prostate cancer and was a promising agent in the treatment of advanced renal cell carcinoma in combination with Interferon-alpha. Usually the age of the patient with urological malignancy, excluding testicular cancer, is high and complicated. For such patients, an aggressive intravenous chemotherapy can not always be used. Therefore, a less aggressive, less toxic chemotherapy with oral drug is often planned to maintain QOL.

Spontaneous recanalization of postoperative severe graft stenosis. What is the cause and prognosis of the "string sign" in the internal thoracic artery?

A 68-year-old female with unstable angina was treated surgically. She was referred to the surgical ward by cardiologists because of a diagnosis of unstable angina with three vessel disease. On a coronary angiogram (CAG), 90% stenoses were found in the left anterior descending coronary artery (LAD), circumflex (CX), and right coronary artery (RCA). She received elective coronary artery bypass grafting (CABG), in which the left internal thoracic artery (LITA) was anastomosed to the LAD and reversed saphenous vein grafts (SVG) were made to segment 12 of the CX, and segment 4PD of the RCA, respectively. The postoperative course was uneventful, but postoperative early graftgraphy revealed distal narrowing of the LITA graft as the so-called "string sign". However, one year post surgery, the LITA string sign was not found and its patency had markedly improved on the second graftgram. It is reported that the LITA "string sign" might cause late graft occlusion. However, this LITA graft evidently enlarged the size and increased the flow of the artery in proportion to myocardial blood demand. To our knowledge, it has not been reported that an in situ LITA string sign on postoperative early graftgram has disappeared in the late phase. We hypothesize that the LITA string sign might be caused by several different factors such as flow competition, spasm, and/or technical problems. In any event, the LITA string sign does not cause graft occlusion in the late postoperative period in every case.

Effects of phosphodiesterase inhibitors after coronary artery bypass grafting

The aim of this study was to estimate the postoperative effects of phosphodiesterase (PDE) inhibitors (milrinone and olprinone) after coronary artery bypass grafting (CABG). To prevent hypotension caused by the PDE inhibitors, low dose of catecholamines were used concomitantly. A total of 34 elective CABG cases were tested. In 12 cases, 0.25 microg kg(-1) min(-1) of milrinone, 3 microg kg(-1) min(-1) of dobutamine (DOB) and dopamine (DOA) were used concomitantly (Group-M). In another 10 patients, 0.1 microg kg(-1) min(-1) of olprinone and the same doses of the catecholamines were infused (Group-O). As a control, the same doses of DOA and DOB only were administered in 12 patients (Group-C). When the pump flow of the cardiopulmonary bypass (CPB) decreased to half, these drugs were given in all groups. Hemodynamics were recorded before CPB, just after the operation, and 3, 6, 12, 24, 48 and 72 h after the operation. Both milrinone and olprinone increased the cardiac index and decreased systemic vascular resistance to almost the same degree. Olprinone decreased mean aortic and pulmonary artery pressures, and also significantly reduced the preload of both right and left heart compared with milrinone. Significant hypotension was not detected due to the concomitant usage of low-dose catecholamines. This concomitant usage of PDE inhibitors and catecholamines allowed easy weaning from CPB, demonstrating excellent hemodynamics after CABG. Good oxygen demand and supply balance were maintained in peripheral tissue. These results suggest that these new PDE inhibitors may be effective not only for weaning from CPB but also for post-cardiotomy cardiogenic shock.

The mechanism of injury in a steatotic liver graft during cold preservation

BACKGROUND

Fatty livers are more prone to primary nonfunction after transplantation. It is known that cell injury is strongly associated with alterations in the content and composition of membrane lipids. We assumed that plasma membrane (PM) fluidity, which is the most important property of the membrane, differed between fatty and normal livers.

METHODS

The livers from obese and lean Zucker rats were flushed with cold Ringer's lactate and University of Wisconsin (UW) solution via the portal vein and preserved in cold UW solution for 24 hr. Histological examinations of electron microscopy were performed to investigate of sinusoidal lining cells (SLCs). PMs were isolated using a discontinuous density gradient of Percoll, and the lipid compositions were determined by chromatography.

RESULTS

SLCs of fatty livers were markedly injured compared with control livers even after short preservation time. Moreover, many blebs were observed in the obese rats even after short preservation time. As for PM lipid composition, the cholesterol/phospholipid (PL) ratio of total PM was 0.14+/-0.03 in the obese rats and 0.21+/-0.03 in the lean rats (P<0.05). The relative proportions of polyunsaturated fatty acids among PLs in PM were 35.7+/-1.2% vs. 45.9+/-1.5% (P<0.0001). These results indicated that the fluidity of the PM in the obese rats is decreased after exposure to low temperatures.

CONCLUSIONS

Our results suggest that steatotic livers from obese donors are more susceptible to cold preservation injury than livers without steatosis because of the severe deterioration of SLCs, and it is associated with PM fluidity even after short-term cold preservation.

Spontaneous pneumothorax complicating lung metastasis from lingual carcinoma

We report a patient with pneumothorax caused by a metastatic tumour from carcinoma of the tongue, which had given rise to a bronchopleural fistula with subsequent induction of pneumothorax. Although rare, pulmonary metastasis should be considered in the aetiology of spontaneous pneumothorax. Despite advanced disease, surgical treatment may be feasible.

Congenital coronary artery fistula treated surgically in the right atrium and the atrial septum

Various surgical techniques have been employed according to the type of the coronary fistula. In this case, preoperative examinations by aortography and MRI revealed a coronary artery fistula which originated from a site just proximal of the RCA, ran through the interatrial septum and drained into the posterior wall of right atrium. The ratio of pulmonary to systemic blood flow (Qp/Qs) was 1. 95. During surgery, we were not able to ligate or divide the fistula on the cardiac surface because the fistulous vessel originated from the posterior aspect of the proximal RCA. After establishing a cardiopulmonary bypass, the opening of the fistula in the right atrium was closed with an autologous pericardium patch, the surface of the interatrial septum was incised and the fistula was identified. The conduit was then divided and closed in the atrial septum. The postoperative course was uneventful. This approach is able to interrupt the fistula safely without interfering with normal coronary flow. Closure of the outlet and division of the fistula itself is a recommendable method to insure interruption of fistulous communication.

Post-operative effects of olprinone after coronary artery bypass grafting

The aim of this study was to test the effects of olprinone after coronary artery bypass grafting (CABG). In order to prevent hypotension caused by olprinone, low doses of catecolamines were used concomitantly. Total 22 elective CABG cases were evaluated. In all cases, moderate hypothermia and cardioplegic cardiac arrest were performed. In 10 cases, continuous intravenous 0.1 microg/kg/min of olprinone, 3 microg/kg/min of dobutamine (DOB) and dopamine (DOA) as the initial doses, were used concomitantly (Group I). As a control, the same initial doses of catecolamine (DOB and DOA) of Group I were administered in another 12 patients (Group II). When the pump flow of cardiopulmonary bypass (CPB) was decreased to half, these drugs were administered in both groups. Hemodynamics were recorded before CPB, just after the operation and 3, 6, 12, 24, 48, and 72 hours after the operation. Three hours after the operation, both mean aortic pressure (AoP) and pulmonary artery pressures (PAP) of Group I demonstrated significantly lower values than those of Group II. Cardiac index (CI) of Group I showed significantly higher values than that of Group II until 6 hours after surgery. The systemic vascular resistance index (SVRI) of Group I indicated a significantly lower value than that of Group II until 24 hours after the operation. Pulmonary capillary wedge pressure (PCWP) of Group I demonstrated a significantly lower value than that of Group II. There were no significant differences in urine output, oxygen delivery (DO2) and oxygen consumption (VO2) between both groups. Olprinone increased CI and decreased SVRI, and it showed easy weaning from CPB, demonstrating excellent hemodynamics after CABG. These results suggested that this new phosphodiesterase inhibitor may be effective for not only weaning from CPB but also post-cardiotomy cardiogenic shock.

Acanthosterol sulfates A-J: ten new antifungal steroidal sulfates from a marine sponge Acanthodendrilla sp

Ten new steroidal sulfates, acanthosterol sulfates A-J (1-10), have been isolated from a marine sponge, Acanthodendrilla sp., collected in western Japan. Acanthosterol sulfates I and J (9 and 10) showed antifungal activity against the yeast Saccharomyces cerevisiae A364A and its mutants at 0.1 mg/disk.

Isolation and characterization of a rice cDNA encoding the gamma-subunit of translation elongation factor 1B (eEF1Bgamma)

We isolated a rice cDNA clone (refg) encoding the gamma-subunit of translation elongation factor 1B (eEF-1B gamma; the old designation was EF-1 gamma). The refg encodes an open reading frame of 419 amino acids which shows a similarity to the equivalent sequences from animals and yeast. Complex formation analysis, which showed the recombinant protein of refg (His-eEF1B gamma) and formed a complex with GST-eEF-1Bbeta, indicated that the refg encodes rice eEF1B gamma of the eEF1B alphabeta gamma complex. Expression analysis showed that refg mRNA is very abundant in suspension-cultured cells during the exponential phase of growth. A DNA blot analysis indicated that refg is located at a single locus in the rice genome.

Effects of concomitant usage of milrinone and catecholamine for weaning from cardiopulmonary bypass

To estimate the effectiveness of concomitant usage of milrinone and catecholamine for weaning from cardiopulmonary bypass (CPB), a clinical study was made, in elective coronary artery bypass grafting (CABG) cases. 24 consecutive patients underwent elective CABG in our institute. In all cases, moderate hypothermia and cardioplegic(St. Thomas solution) cardiac arrest were performed. In 12 cases, continuous intravenous 0.25 microgram/kg/min of milrinone, 3 micrograms/kg/min of dobutamine (DOB) and dopamine (DOA) as the initial doses, were used concomitantly as inotropic agents (Group-I). The same initial doses of catecholamine (DOB and DOA) as the Group-I were administered in another 12 patients (Group-II). When the pump flow of CPB decreased to a half, these drugs were administered in both groups. Hemodynamic data were measured before CPB, just after operation, 3, 6, 12, 24, 48, and 72 hours after operation. There were no significant differences in aortic and pulmonary artery pressure between both groups. However, cardiac index (CI) of the Group-I demonstrated significantly (p < 0.01) higher values than that of Group-II until 24 hours after surgery. Systemic vascular resistance index (SVRI) of the Group-I demonstrated significantly (p < 0.01) lower value than that of Group-II from 3 to 12 hours after operation. There were no significant differences in oxygen delivery (DO2) and oxygen consumption (VO2) between both groups. These results suggested that concomitant usage of milrinone and low dose catecholamine increased CI and decreased SVRI, and made weaning from CPB very easy, demonstrating excellent hemodynamics. This high potential phosphodiesterase inhibitor may be suitable for not only weaning from CPB but also post-cardiotomy cardiogenic shock.

Neutropenic colitis as a complication of high-dose chemotherapy for refractory testicular cancer

A 44-year-old man received high-dose chemotherapy with carboplatin, etoposide and cyclophosphamide followed by autologous peripheral-blood stem-cell transplantation for treatment of refractory nonseminomatous testicular cancer (seminoma plus choriocarcinoma). The patient developed fever, watery diarrhea and abdominal pain at 10 days after the initiation of high-dose chemotherapy. Radiological examinations revealed adynamic ileus with thickened colon and small bowel wall and increasing ascites over the next 3 days. The patient subsequently suffered from disseminated intravascular coagulation, renal failure and hyperbilirubinemia despite systemic antibiotic therapy. Intensive medical care could barely avoid the fatal outcome. Neutropenic colitis has been recognized as a complication of acute leukemia or aplastic anemia. The present case indicates that this serious gastrointestinal complication can occur under profound neutropenic conditions induced by intensive chemotherapy for solid cancer.

Second primary cancers after resection of lung adenocarcinoma with ras gene mutation

BACKGROUND

Ras gene mutations are associated with a poor prognosis in patients with adenocarcinoma of the lung. However, the association between cases with ras gene mutation and an occurrence of second primary cancer is unknown.

MATERIALS AND METHODS

We examined 89 adenocarcinoma of the lung obtained from patients treated by curative resection, and four second primary cancers, for mutation at codons 12, 13, and 61 of three ras oncogenes using polymerase chain reaction and oligonucleotide hybridization techniques.

RESULTS

Ras gene mutations were detected in 13 cases. Six patients died from recurrent disease within 3 years. Of the seven patients who survived over 5 years, three patients demonstrated a metachronous second primary cancer after the operation for lung cancer, and one patient had synchronous laryngeal cancer. Two of the cases with second primary cancer demonstrated the ras gene mutation. One had the same mutation as that of the primary lung cancer, and the other had a different mutation from the first lung cancer.

CONCLUSION

Ras gene mutations play an important role in tumor progression of lung adenocarcinoma and also might have an role in the carcinogenesis in respiratory tract cancer.

Macroscopic aspects of cloth-covered Starr-Edwards prostheses at reoperation: what the precursory valve teaches us

BACKGROUND AND AIMS OF THE STUDY

Cloth-covered Starr-Edwards ball valves were the first choice in prosthetic substitution at the authors' institution between June 1968 and March 1977. This study investigated, retrospectively, macroscopic aspects of the prostheses at reoperation.

METHODS

Among 59 survivors who underwent isolated aortic or mitral valve replacement, 12 required reoperation for valve dysfunction (five aortic valve replacements, seven mitral valve replacements). Reoperation was necessitated by valvular endocarditis, paravalvular leak, hemolysis, thromboembolism, orifice stenosis attributable to pannus, and inappropriate sizing related to growth and thrombus. The mean time to reoperation was 11.7 +/- 6.2 years after initial surgery (range: 2 years 4 months to 21 years 8 months).

RESULTS

Marked cloth wear was observed in all aortic prostheses, but only slight wear in mitral valves. Pannus formation was observed around the orifice in both aortic and mitral prostheses, but strut cloth was not extensively covered by autologous tissue. In mitral valves, strut cloth was only slightly worn and less loose than that of the aortic valve. These changes notably affected prosthetic valve function, the most significant problem in mitral prostheses being thrombus (four of seven valves).

CONCLUSIONS

Pannus formation and thrombus caused by the reaction of the patient's tissues remain major problems in the use of artificial valves, and require further work for their improvement.

Neuroprotective effect of YM-39558 in focal cerebral ischemia in cats

We studied the effect of YM-39558, orotic acid ethylester, in a focal cerebral ischemia model in anesthetized cats. YM-39558 has good permeability across the blood brain barrier, and in the brain is hydrolyzed to orotic acid, the main active substance. Cats were subjected to permanent occlusion of the middle cerebral artery (MCA) for 6 h, then killed and examined histologically. Treatment with YM-39558 (intravenous infusion of 11.8 mg (10 mg as orotic acid)/6 ml per kg per h) starting 15 min after MCA occlusion markedly reduced the volume of ischemic damage (from 2450 +/- 82 mm3 of the cerebral hemisphere in the saline-treated cats to 1644 +/- 123 mm3 in the YM-39558-treated cats, P < 0.01). In contrast, YM-39558 (2.26 and 1.18 mg/0.8 ml per kg per h) showed no significant protective effect on ischemic damage. No significant differences were observed between saline- and YM-39558-treated cats concerning physiological variables including brain temperature. This evidence for the neuroprotective efficacy of YM-39558 in gyrencephalic species suggests its therapeutic potential in the treatment of stroke in humans.

Synthesis and pharmacological characterization of novel 6-fluorochroman derivatives as potential 5-HT1A receptor antagonists

A series of novel 6-fluorochroman derivatives was prepared and evaluated as antagonists for the 5-HT1A receptor. N-2-[[(6-Fluorochroman-8-yl)oxy]ethyl]-4-(4-methoxyphenyl)butylami ne (3; J. Med. Chem. 1997, 40, 1252-1257) was chosen as a lead, and structural modifications were done on the aliphatic portion of the chroman ring, the tether linking the middle amine and the terminal aromatic ring, the aromatic ring, and lastly the amine. Radioligand binding assays proved that the majority of the novel compounds behaved as good to excellent ligands at the 5-HT1A receptor, some of which were selective with respect to alpha1-adrenergic and D2-dopaminergic receptors. The antagonist activity of the compounds was assessed in the forskolin-stimulated adenylate cyclase assays in CHO cells expressing the human 5-HT1A receptors. Among the modifications attempted, introduction of an oxo or an optically active hydroxy moiety at the chroman C-4 position was effective in ameliorating the receptor selectivity. Six analogues were selected through the in vitro screens and further evaluated for their in vivo activities. A 4-oxochroman derivative (31n), having a terminal 1, 3-benzodioxole ring, demonstrated antagonist activities toward 8-OH-DPAT-induced behavioral and electrophysiological responses in rats.

Left atrial myxoma with an atrial septal defect: a case report and review of the literature

We report a case of a 49 year-old Japanese woman with a left atrial myxoma complicated by an atrial septal defect diagnosed intraoperatively, which was classified as in secundum defect and was 28x110 mm in diameter. The tumor, which was attached by a pedicle to the posterior wall of the left atrium near the posterior commissure of the mitral valve, was removed together with a small portion of the left atrial wall. The postoperative course was uneventful. The pathologic findings were consistent with the diagnosis of myxoma. Since the defect was functionally canceled by the myxoma, the diagnosis of an atrial septal defect was not confirmed preoperatively even by color Doppler echocardiography and cardiac catheterization. Tumor embolization is one of the critical complications of myxoma. Fortunately, she didn't suffer from either systemic or pulmonary emboli. During surgery of myxoma with atrial septal defect, careful manipulation is needed, especially at caval cannulation so as not to damage the tumor directly. In the cases with atrial septal defect or patent foramen ovale, myxomas are generally situated on the interatrial septum. However, in this case the tumor was located on the posterior wall of the left atrium.

Clinical experiences of percutaneous cardiopulmonary support: its effectiveness and limit

In recent years, several types of centrifugal pumps have been widely used as the main pumps for cardiopulmonary bypass (CPB) and postcardiotomy cardiac support. From April 1990 to March 1997, a percutaneous cardiopulmonary support (PCPS) system was used in 20 patients with an average age of 58 years (13 males and 7 females). They comprised 11 ischemic, 6 valvular, 2 aortic, and 1 congenital heart disease patients. Our PCPS system consists of a centrifugal pump (BioMedicus BP-80), an oxygenator, and a reservoir. The entire blood contacting surface, including that of the thin wall cannulas, is coated by heparin bonded materials. As a result of this new technology, this system can be used for the long term without systemic heparinization. No major critical thrombi were revealed inside the pumps or circuits. Of the 20 patients, 7 (35%) (Group 1) could be weaned from PCPS, and the remaining 13 (Group 2) could not. In Group 1 although 2 patients suffered from renal failure and pneumonia, respectively, both were discharged from our hospital. The long-term survival rate was 35%. In Group 2 cerebral vascular damage was recognized in 3 patients, renal failure in 4, multiple system organ failure in 4, bleeding in 2, arrhythmia in 1, and leg ischemia in 2. Pulse pressure was significantly elevated due to the recovery of the native heart in Group 1, 2 days after support. However, in Group 2, it did not elevate, and the left ventricular ejection fraction was less than 30%, associated with high left atrial pressure. In conclusion, this heparin coated PCPS system was very simple and easy to control. It demonstrated long-term biocompatibility and was very effective in recovering deteriorated cardiac function. Quicker application of this system can play an important role in preventing severe complications and obtaining better clinical results. If long-term support is necessary, a ventricular assist device (VAD), which is more powerful, durable, and biocompatible, has to be applied instead of PCPS.

Determinations of free and bound ethanol, acetaldehyde, and acetate in human blood and urine by headspace gas chromatography

The improved PCA method leads to accurate measurement of ethanol, acetaldehyde, and acetate in blood and urine by headspace gas chromatography. It is important to prevent the formation of artifactual acetaldehyde from coexistent ethanol. The column used for detection of alcohol metabolites was the fused silica glass capillary column bonded with PEG-20M or the fused silica glass capillary column of Pora PLOT Q. In bound alcohol metabolites, recent measurements of hemoglobin-associated acetaldehyde in blood, and ethanol conjugate and acetaldehyde conjugate in urine are reviewed and described as a marker of alcohol abuse.

Neuroprotective effect of YM-39558, orotic acid ethylester, in gerbil forebrain ischemia

We studied the effects of orotic acid and YM-39558 (2,6-dioxo-1,2,3,6-tetrahydropyrimidine-4-carboxylic acid ethyl ester), orotic acid ethylester, on delayed neuronal death of hippocampal CA1 neurons induced by transient forebrain ischemia. Our data indicated that YM-39558 had high permeability across the blood brain barrier and was hydrolyzed to orotic acid, the active substance, in the brain. The neuronal damage was reduced significantly in animals intraperitoneally treated with YM-39558 (100 mg/kg x 3) after ischemia, but not with orotic acid in the same way. The results also suggested that the maintenance of a few ten micromolar orotic acid in cerebrospinal fluid were needed for its neuroprotective effects.