Comparison of the effects of meperidine and nalbuphine on intrapartum fetal heart rate tracings

OBJECTIVE

To examine the effects of meperidine and nalbuphine on intrapartum fetal heart rate (FHR) tracings using computer analysis.

METHODS

We studied 28 women with uncomplicated pregnancies in early labor at term with reactive FHR tracings. The women were randomized to receive either meperidine 50 mg or nalbuphine 10 mg intravenously on request. One-hour FHR recordings were obtained before and immediately after administration of the medications.

RESULTS

There were no significant differences in the FHR characteristics of the two groups during the pre-treatment period. Nalbuphine significantly decreased the number of accelerations of 10 beats per minute (17 versus 4, P = .003) and 15 beats per minute (10 versus 1.5, P = .001), time spent in episodes of high variation (35.5 versus 10 minutes, P = .004), long-term variation (47 versus 29.8 milliseconds, P = .002), and short-term variation (8.4 versus 6.4 milliseconds, P = .03). Meperidine had no significant effect on any FHR characteristic.

CONCLUSION

In the early intrapartum period of normal term pregnancies and at commonly used dosages, nalbuphine had a significant effect on FHR tracings, whereas meperidine had no effect, as determined by computer analysis.

Development of cockroach-allergic guinea pig by simple room air contamination

Asthma is frequently associated with inhalant sensitivities, particularly allergens of indoor environment. The aim of the study is to determine whether an indoor allergen, cockroach (CRa), can induce guinea pig sensitization without adjuvant or special manipulation. Six regimens were used in sensitizing guinea pigs by CRa aerosols: low daily (C-I), low intermittent (C-II), high intermittent (C-III), maximum intermittent (C-IV), high daily (C-V) and high alternate day (C-VI) doses, and results were compared with that of intraperitoneal sensitization (C-VII). Also studied was a role of CRa in the aerosol ovalbumin (OA) sensitization in comparison with placebo and an adjuvant, Al(OH)3. Reaginic guinea pig antibodies, anti-CRa-IgGla-like (IgGla) and IgE-like (IgE), were measured by passive cutaneous anaphylaxis (PCA). Results show that IgGla was produced only in high-dose aerosol groups, C-V and C-VI, but no IgE in all aerosol groups. The antibody was detected on day 22 (C-V) and day 19 (C-VI) and sustained till day 52 (titers 1:20 to 1:200). The preliminary pulmonary function measurements revealed that the sensitized animals (C-VI) showed a decreased ventilatory function upon CRa challenge. Aerosolized OA sensitization also produced anti-OA-IgGla in high intermittent regimens. In addition, PCA titers (anti-OA-IgGla) in OA-sensitized animals were not influenced by pretreatment with CRa, Al(OH)3, or placebo. Thus, the study indicates that simple aerosolized CRa contamination in a chamber makes guinea pigs cockroach-sensitive and become asthmatic. Yet, CRa does not enhance other allergen sensitization.

Effects of ultrasonic scaling and periodontal curettage on surface roughness of porcelain

Changes in the surfaces of glazed porcelain were evaluated with the use of a profilometer and a scanning electron microscope after ultrasonic scaling and periodontal curettage. Thirty samples of glazed porcelain-fused-to-metal were divided into two experimental zones, and the two scaling treatments were performed on each sample. Measurements of surface roughness of porcelain were made before and after instrumentation for both periodontal prophylaxis procedures. The statistical analysis of the differences in surface changes as evaluated on the profilometer indicated that the roughness alterations from both procedures were not statistically significant; however, the qualitative or subjective evaluation of scanning electron micrographs and profile tracings revealed differences between glazed and instrumented porcelain surfaces.

Age-dependent mechanism in guinea pig bronchoconstriction induced by exsanguination

Age-related mechanism in exsanguination-induced bronchoconstriction (EIB) was studied in guinea pigs. We used a total of 36 guinea pigs divided into three age categories (immature, adolescent, and mature). Each age category was separated into two groups: control and catalase (CAT). CAT is an antioxidant. Both saline (the control group) and CAT were instilled intratracheally 30 min before exsanguination. The animals were anesthetized, sternotomized and exsanguinated. Maximal expiratory flow (Vmax) was measured both before and 1-30 min after exsanguination. In the control group, exsanguination caused gradual decreases in both total lung capacity (TLC) and Vmax at 50% baseline TLC, and an increase in minimal lung volume, indicating EIB. EIB occurred faster in the immature than in the adolescent and mature guinea pigs, and it was significantly ameliorated by CAT. In 36 additional animals tested before exsanguination, there was no age-related change in either airway neutral endopeptidase (NEP) activity or lung tissue substance P level. Thirty minutes after exsanguination in the control groups, airway NEP activity decreased significantly in all age categories, while lung tissue substance P level increased significantly only in the immature category. CAT prevented most of these NEP and substance P changes. These data suggest that exsanguination increases production of oxygen radicals, which inactivate NEP and enhance breakdown of substance P precursor; the increased tachykinin levels induce EIB. Furthermore, our data indicate that this chain reaction is age-dependent, with a faster and more severe reaction in immature guinea pigs.

Capsaicin pretreatment attenuates chronic hypoxic pulmonary hypertension

Capsaicin pretreatment was used to deplete tachykinins in order to study the role of tachykinins in chronic hypoxia-induced pulmonary hypertension. Forty three young Wistar rats weighing 235 +/- 4 g were randomly divided into four groups: control (n = 10); capsaicin pretreatment (n = 10); intermittent chronic hypoxia (n = 10); and capsaicin pretreatment + intermittent chronic hypoxia (n = 13). Control animals breathed room air. Rats in the capsaicin pretreatment groups were given capsaicin via subcutaneous injection over a three-day period. Hypobaric hypoxia was intermittently applied by placing animals into a hypobaric chamber with a barometric pressure of 380 Torr for two weeks. In the capsaicin pretreatment + intermittent chronic hypoxia group, rats were exposed to intermittent hypoxia for two weeks immediately after the last dose of capsaicin. Subsequently, pulmonary vascular function, as well as substance P (a tachykinin) level and neutral endopeptidase (NEP, the major degradation enzyme for tachykinins) activity in the lungs were measured. Chronic hypoxia caused significant increases in pulmonary artery pressure, right ventricle/(left ventricle + septum) weight ratio, hematocrit, and lung substance P level, as well as a significant decrease in lung NEP activity. All these chronic hypoxia-induced changes were significantly lessened by capsaicin pretreatment. Capsaicin pretreatment alone did not induce any significant alteration in vascular function. These results suggest that the chronic hypoxia causes an increase in lung tachykinin levels which, in turn, enhance the development of pulmonary hypertension.

Guided tissue regeneration in surgically created 3-walled and 2-walled periodontal osseous defects in monkeys

BACKGROUND

In the previous clinical studies, guided tissue regeneration resulted in periodontal regeneration after treatment of 3-walled intrabony defects. The purpose of the present study was to compare the regenerative potential of 3-walled and 2-walled surgically created periodontal osseous defects in monkeys following placement of a biocompatible, porous polytetrafluorethylene membrane.

METHODS

In each of 8 Taiwan monkeys, 2 maxillary and 2 mandibular teeth were selected for experimentation. Using a diamond bur, 3-walled osseous defects were created on the distal of the maxillary cuspid and the mesial of the mandibular second bicuspid of one side. Two-walled (lingual wall and proximal wall) osseous defects were created on the contralateral side. After root planing, teflon membranes were applied to the mandibular test teeth. In the maxilla, all procedures were the same except for the placement of teflon membranes. Two monkeys were sacrificed 3, 6 and 9 months after operation and prepared for histologic and histometric evaluation. Reentries were performed while the other 2 monkeys were terminated 11 months after operation.

RESULTS

Histologic evaluation revealed that new connective tissue attachments were found to a greater extent in the 3-walled periodontal osseous defects treated with teflon membranes compared with the non-membrane sites (p = 0.05). More periodontal regeneration was not predictably obtained in the surgically created 2-walled osseous defects when the teflon membranes were used.

CONCLUSIONS

For 3-walled periodontal osseous defects, guided tissue regeneration was superior to conventional periodontal flap surgery. For 2-walled defects, new connective tissue attachment could not be predictably achieved.

Sidestream cigarette smoke exposure and airway reactivity during early life

We established a guinea pig model to investigate effects of in utero and neonatal exposure to sidestream cigarette smoke (SSCS) on bronchial reactivity during early life. Animals were divided into four groups: 1) room air/room air, 2) sham/sham, 3) SSCS/room air, and 4) SSCS/SSCS. Pregnant and neonatal animals of group 1 breathed room air and those of group 2 were sham treated. Pregnant animals of both groups 3 and 4 as well as neonates of group 4 were exposed to SSCS. SSCS exposure was limited to between days 28 and 55 of pregnancy and days 8 and 24 of the neonatal period. Bronchial response to acetylcholine (ACh) and substance P (SP) were determined in very young animals at 25 days of age. Maximal expiratory flow was used as an index of airway dimension. SP, but not ACh, induced a significantly larger decrease in peak maximal expiratory flow in group 4, indicating an important role of neonatal SSCS exposure in augmenting bronchial response to SP. To further investigate the role of tachykinins in cigarette smoke-induced changes in bronchial reactivity, four additional groups (the same as above) of neonates were pretreated with capsaicin to deplete tachykinins. In the SSCS/SSCS group, SP-induced airway hyperreactivity was abolished by capsaicin pretreatment. Furthermore, in all four groups, capsaicin pretreatment abolished the bronchial response to SP but not the response to ACh. In additional very young animals, acute SSCS caused a nonsignificant increase in bronchial response to SP. These results indicate that chronic neonatal SSCS exposure induces bronchial hyperreactivity to SP; this hyperreactivity is abolished by capsaicin pretreatment.

[Continuing hospice care of cancer--a three-year experience]

The hospice at Mackay Memorial Hospital was established in February 1990. A group of team workers including physicians, nurses, social workers and the clergy were involved in this holistic care program for terminal cancer patients. Four hundred and seventy-nine patients were eligible for the program up to February 1993. Regarding duration of stay, 62.5% of patients resided for 14 days. Those surviving under 90 days constituted 75.5% of patients. Fifty-one point eight percent of patients died in the hospice and 18.2% died at home soon after being discharged from the hospice. Pain is the most common symptom among the patients. Treatment strategies vary according to the three-step-ladder protocol designed by WHO. Total pain relief was achieved in 80% of patients. Opportune private talking and family conferences formed the basis of the "peer model". Through this model, treatment decisions including physical, psychosocial and spiritual issues were made. Before the peer model, only 36 (10.3%) patients agreed with the idea of hospice care, while 257 (73.6%) patients agreed after the model was established. Awareness of dying was evident in 412 (86%) patients. Two hundred and eighty (68%) patients became aware of the prospect of death through guessing, while the other 132 (32%) patients were informed by medical staff. Problems encountered by the team workers included 1) needs in education and training, 2) psychological pressure, 3) management of loss and grief, 4) needs in supportive system and 5) troubles caused by families' lying to patients. The team workers were satisfied with the quality of care in 38.4% of patients and fairly satisfied with 30.7% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Oxygen radicals in exsanguination-induced bronchoconstriction of guinea pigs

This study investigated the relationship between oxygen radicals and exsanguination-induced bronchoconstriction using antioxidant in guinea pigs. To accomplish this, two phases of studies were carried out. In phase 1, 34 guinea pigs weighing 342 +/- 11 g were divided into five groups: control (n = 7); acute dimethylthiourea (DMTU, n = 7); chronic DMTU (n = 8); superoxide dismutase (SOD, n = 6); and catalase (n = 6). Animals in the control group were not treated. DMTU, SOD, and catalase were employed for the scavenging of hydroxyl radical, superoxide anion, and hydrogen peroxide, respectively. Ten additional guinea pigs weighing 293 +/- 6 g were divided into two groups in phase 2: sham (n = 6) and chronic apocynin (n = 4). Animals in the sham group received injections of the vehicle, whereas apocynin was used to suppress the production of superoxide anion. All animals were anesthetized, sternotomized, and artificially ventilated. Before (baseline) as well as at fixed intervals 5-30 minutes following the exsanguination, the maximal expiratory flow maneuver was performed and the dynamic compliance (Cdyn) was obtained. Decreases in the maximal expiratory flow at 50% baseline vital capacity and Cdyn were used as indicators of bronchoconstriction. Exsanguination in the control and sham groups caused a gradual increase in airway constriction with time that was significantly ameliorated by chronic DMTU and chronic apocynin pretreatments but was not affected by other acute treatments. These results indicate that chronic treatment with antioxidants ameliorates exsanguination-induced, tachykinin-mediated airway constriction.

Management of anorexic patients in radiotherapy: a prospective randomized comparison of megestrol and prednisolone

Megestrol acetate and corticosteroid have been demonstrated to be effective in the treatment of anorexia in patients with advanced cancer. The purpose of this preliminary study is to evaluate the role of megestrol acetate and prednisolone in the treatment of anorexia induced during whole pelvis external irradiation. Fifty-two patients were randomized in this prospective study to either receive megestrol acetate (40 mg orally four times a day), prednisolone (10 mg orally three times a day), or placebo (1 tablet orally three times a day) for 21 consecutive days. Body weight, appetite, performance status, sense of well-being, and complications were assessed every 3 days. Both the megestrol acetate group and the prednisolone group showed improvement in body weight gain, appetite, performance status, and sense of well-being. Appetite improvement was statistically significant in the megestrol acetate group (P = 0.024) when compared with the placebo group. There were no complications during the 21-day trial.

Intratracheal antioxidants attenuate exsanguination-induced bronchoconstriction in guinea pigs

The role of oxygen radicals in exsanguination-induced bronchoconstriction (EIB) was investigated using intratracheal instillation of antioxidants. In series 1, 49 guinea pigs (331 +/- 6 g) were employed in the functional study. These animals were divided into seven groups: control, superoxide dismutase (SOD), catalase (CAT), erythrocytes (RBCs), N-[2-(2-oxo-1-imidazolindinyl)-ethyl]-N'-phenylurea (EDU), ruthenium red (RR), and systemic capsaicin pretreatment. SOD, CAT, RBCs, and EDU are antioxidants, whereas RR is a blocker of transmembrane Ca2+ fluxes. All agents except capsaicin were administered by intratracheal instillation 30 min before exsanguination; each animal of the last group received a 5-day subcutaneous capsaicin pretreatment. All animals were anesthetized, sternotomized, and exsanguinated. Before as well as 1-30 min after exsanguination, the maximal expiratory flow maneuver was performed and the minimal volume was obtained. In the control group, exsanguination caused gradual decreases in the maximal expiratory flow at 50% baseline total lung capacity, forced expiratory volume at 0.1 s, and total lung capacity as well as a gradual increase in the minimal volume, indicating that EIB becomes more severe with time. EIB was significantly ameliorated by intratracheal instillation of SOD, CAT, RBCs, EDU, and RR, and it was almost abolished by systemic capsaicin pretreatment. In series 2, however, inactivated CAT did not significantly affect EIB. We determined tracheal neutral endopeptidase (NEP) activity in 23 animals. Thirty minutes after exsanguination, there was a significant decrease in NEP activity in the control but not the CAT group. These results indicate that EIB is modulated by oxygen radicals, which inactivate NEP.(ABSTRACT TRUNCATED AT 250 WORDS)

Capsaicin pretreatment attenuates monocrotaline-induced ventilatory dysfunction and pulmonary hypertension

In view of bronchoconstrictor and proliferative effects of tachykinins (TKs; mainly substance P and neurokinin A), as well as increased TK release during tissue injury, we hypothesized that monocrotaline (MCT)-induced ventilatory dysfunction and pulmonary hypertension may be mediated via TKs. In phase 1 of the study (n = 19 rats), we tested and found that elevated lung substance P level and suppressed neutral endopeptidase activity occurred 1-2 wk post-MCT (60 mg/kg sc). Both phase 2 (n = 32) and phase 3 (n = 32) young Sprague-Dawley rats were divided into five groups: control, sham, capsaicin, MCT, and capsaicin + MCT. Rats in the control group received no treatment. Each sham rat received the vehicles. Chronic capsaicin treatment was used to deplete neuropeptides. Each MCT rat received a single injection of MCT 1 wk (phase 2) or 3 wk (phase 3) before the functional study. Each capsaicin + MCT rat received the MCT administration 3 days after the completion of capsaicin pretreatment. In the MCT group, there were significant decreases in dynamic compliance, quasi-static compliance, and the maximal expiratory flow rate at 50% total lung capacity in phase 2, which was accompanied by significant increases in pulmonary arterial pressure, the weight ratio of right ventricle/(left ventricle + septum), and the arterial medial wall thickness in phase 3. In the capsaicin + MCT group, however, all the above MCT-induced changes were significantly attenuated or abolished. All values from the sham and capsaicin groups were not significantly different from those of the control group. These data demonstrate that MCT induces pneumotoxicity, accompanied by elevated levels of substance P in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of vagus nerves in resiniferatoxin-induced bronchoconstriction of guinea pigs

To study the role of vagal afferent C-fibers in resiniferatoxin (RTX)-induced bronchoconstriction in vivo, 30 guinea pigs weighing 347 +/- 28 g were evenly and randomly divided into five groups: Group 1, control; 2, chronic vagotomy; 3, local capsaicin (acute); 4, local capsaicin (chronic); and 5, systemic capsaicin. Each animal was anesthetized with pentobarbital sodium, cannulated with a tracheal cannula and venous catheter, paralyzed with gallamine triethiodide, and artificially ventilated. All animals were pretreated with atropine and phenoxybenzamine. Immediately after RTX was intravenously injected, each animal in the control group exhibited profound decreases in maximal expiratory flow, dynamic respiratory compliance, and total lung capacity, as well as an increase in functional residual capacity, indicating severe airway constriction. Animals in Groups 2-4 exhibited partial abolishment, while those in Group 5 showed complete abolishment of the RTX-induced bronchoconstriction. In 12 additional animals (6 animals each in control and chronic vagotomy groups), chronic vagotomy caused also suppressive effects on capsaicin-induced airway constriction. At one min, our data demonstrate that 36-51% of noncholinergic bronchoconstriction is due to the vagal component while the remaining constriction is due to the nonvagal component. Thus, the nonvagal component plays a significant role in this type of tachykinin-mediated airway constriction.

Radiotherapy following simple hysterectomy in patients with invasive carcinoma of the uterine cervix

From January 1980 to December 1988, a total of 73 cases of invasive cervical cancer after simple hysterectomy were treated with radiotherapy. Seven patients were excluded due to incomplete treatment or loss of follow-up. Among the 66 patients, 52 had squamous cell carcinoma and 14 had adenocarcinoma or adenosquamous cell carcinoma. The patients were grouped as follows: group A, patients without gross residual tumor (n = 32); group B, patients with gross residual tumor (n = 23); and group C, patients with gross recurrent tumor (n = 11). All patients in groups A and B received radiotherapy immediately (within 4 months) following their simple hysterectomy. Patients in group C were treated six months to five years later. Different methods of radiotherapy were delivered during the two consecutive time periods. Before 1985, patients (n = 30) were irradiated with a dose of 45-50 Gy in the midpelvic plane, followed by a transvaginal boost of 30 Gy. After 1985, patients (n = 36) were treated with the same midpelvic dose, and boosted with 30 Gy by high-dose-rate brachytherapy. The overall five-year survival rate was 67%. The five-year survival rates were 81% in group A, 56% in group B, and 45% in group C. A low complication rate (10%) was obtained in our series.(ABSTRACT TRUNCATED AT 250 WORDS)

Axon reflex in resiniferatoxin-induced bronchoconstriction of guinea pigs

To study the role of the axon reflex in resiniferatoxin (RTX)-induced bronchoconstriction in vivo, 32 guinea pigs weighing 292 +/- 7 g were randomly divided into five groups: Group 1, control (n = 6); Group 2, chlorisondamine (n = 6); Group 3, tetrodotoxin (TTX, n = 6); Group 4, local capsaicin application (n = 6); and Group 5, systemic capsaicin application (n = 8). Chlorisondamine was used to interrupt ganglionic transmission while TTX was employed to block nerve impulse conduction. In Group 4, capsaicin was locally applied to both cervical vagus nerves 30 min prior to the study whereas capsaicin was given subcutaneously for 5 days starting 9 days before the study in Group 5. Each animal was anesthesized with pentobarbital sodium, cannulated with a tracheal cannula and venous catheter, paralyzed with gallamine triethiodide, and artificially ventilated. All the above animals were treated with atropine (0.2 mg/kg) and phenoxybenzamine (0.5 mg/kg). Resiniferatoxin (2 micrograms/kg) was injected intravenously to induce airway constriction. Immediately upon injection of RTX (at 1 min), each animal in the control group exhibited decreases in maximal expiratory flow, dynamic respiratory compliance, and total lung capacity, indicating severe bronchoconstriction. Then the airway spasm ameliorated gradually with time. Animals in Groups 3 and 4 indicated partial abolishment, while those in Group 5 showed complete abolishment, of the RTX-induced bronchoconstriction. On the other hand, the animals in Group 2 did not display any significant alteration in the RTX-induced bronchospasm. Furthermore, we tested RTX-induced bronchoconstriction in 5 additional animals not pretreated with either atropine or phenoxybenzamine. Compared with the data above, no significant differences in RTX-induced respiratory changes were found. Since it is known that TTX blocks nerve conduction, the data suggest that the TTX-sensitive reflex (the axon reflex) via afferent C-fibers plays a significant role in the RTX-induced bronchoconstriction, which is apparently mediated via tachykinins.

Lung uptake of Tc-99m HMPAO in cigarette smokers expressed by lung/liver activity ratio

Tc-99m HMPAO, a lipophilic radiopharmaceutical used for brain imaging, has been reported to localize in smokers' lungs. To quantitate this uptake in the lung, 55 patients, who were referred for brain imaging for dementias or strokes, also underwent lung imaging (anterior lung imaging includes a large part of the liver) after IV injection of the radiopharmaceutical. Regions of interest over the liver and the lung were calculated. Of the 55 patients (ages 13-79), 30 were smokers and 25 were nonsmokers. The smokers had been smoking from 6-59 years, and daily cigarette consumption ranged from 8-50 cigarettes. The mean lung/liver ratio for smoking patients were 0.792 +/- 0.042 (SE); the mean lung/liver ratio for nonsmoking patients was 0.408 +/- 0.019 (SE). Lung/liver ratio uptake was significantly higher in the smoking patients (P < 0.01) than in the nonsmokers. Thus, lung/liver uptake of Tc-99m HMPAO may be used as an indicator of cigarette smoking.

Oxygen radicals in bronchoconstriction of guinea pigs elicited by isocapnic hyperpnea

The role of oxygen radicals in isocapnic hyperpnea-induced bronchoconstriction (HIB) of guinea pigs was investigated using scavengers of the radicals. In series 1, 50 young guinea pigs were randomly divided into seven groups: control 1, control 2, chlorisondamine, tetrodotoxin (TTX), acute dimethylthiourea (DMTU), tachykinin depletion, and 5% CO2 in air. Animals of the control 2 group received vehicle (saline) infusion while those of the control 1 group did not. Chlorisondamine was used to block ganglionic transmission, TTX to interrupt nerve conduction, DMTU to scavenge hydroxyl radicals, and chronic capsaicin pretreatment to deplete tachykinins. The animals in the last group were ventilated with dry 5% CO2 in air during hyperpnea. In series 2, 13 additional animals were used to test the effects of intratracheal administration of superoxide dismutase and catalase (SOD + CAT) on HIB. Each animal was anesthetized with pentobarbital sodium, cannulated with a tracheal cannula and venous catheter, paralyzed with gallamine triethiodide, and mechanically ventilated. During the baseline period, each animal was ventilated normally with humidified air. Then it was hyperventilated 15 min with a dry gas mixture of 95% O2-5% CO2, except animals in the last group of series 1. Subsequently, all animals returned to normal ventilation with humidified air for 45 min (recovery period). The maximal expiratory flow and dynamic compliance were obtained periodically during the recovery period. The isocapnic hyperpnea using 95% O2-5% CO2, but not 5% CO2 in air, caused bronchoconstriction that was significantly blocked by acute DMTU, acute SOD + CAT, and tachykinin depletion. In an additional group of six animals, acute DMTU did not significantly alter acetylcholine-induced airway constriction.(ABSTRACT TRUNCATED AT 250 WORDS)

High-dose-rate afterloading brachytherapy in carcinoma of the uterine cervix

High-dose-rate (HDR) afterloading brachytherapy has been used at Mackay Memorial Hospital since 1984 for the treatment of gynecological malignancies. From October 1984 to October 1990, a total of 321 previously untreated patients with biopsy proven uterine cervical cancer were treated with radiation therapy with curative intent. According to FIGO staging, the patients were grouped into stage I (19 patients), stage IIA (13 patients), stage IIB (96 patients), stage III (158 patients) and stage IVA (35 patients). All patients received a combination of external beam irradiation plus intracavitary brachytherapy using the Buchler Remote Afterloading (RAL) system. For most cases, external beam irradiation using a Co-60 or Clinac 1800 photon beam (6 MV or 15 MV) of 3,060 cGy to 3,960 cGy was given to the whole pelvis (180 cGy/day, five days/week), followed by a midline shield after RAL. The total dose to the pelvic sidewall was 5,040 cGy to 5,400 cGy. The overall actuarial five-year survival rate was 55%. The total complication rate in a follow-up of two to eight years was 1% to 4%, and a good correlation existed between rectal complications and the calculated rectal dose. We conclude that fractionated HDR intracavitary therapy concurrent with teletherapy can achieve a high regional control rate with few complications, and can reduce the cost of hospitalization and the risk of anesthesia.

[123I]HIPDM pulmonary imaging demonstrates elastase-induced pulmonary emphysema

Because more than 90 percent of [123I]hydroxyiodobenzyl-propanediamine (HIPDM) is localized in the lung after intravenous injection, the radiopharmaceutical has been proposed as a lung imaging agent. Its potential usefulness for the detection of pulmonary emphysema was evaluated in an animal model of elastase-induced emphysema along with [99mTc]MAA lung perfusion imaging. To induce lung emphysema, Long-Evans rats (200-250 g) were given 400 IU/Kg elastase intratracheally under ether anesthesia. Four weeks after elastase treatment, 15 treated and 15 nontreated rats were paired and simultaneously imaged under a scintillation camera immediately following intravenous injection of 0.25-0.3 mCi[99mTc]MAA. The procedure was repeated 48 hr later using 0.25-0.3 mCi[123I]HIPDM. Activity in the region of interest (ROI) over the lungs was recorded after the injections. Total counts per ROI from each rat were measured and normalized by lung volume. The normalized lung activity ratio of treated/nontreated rats was computed. The mean ratios of HIPDM and MAA were 0.847 and 0.802, respectively. The significant decrease in uptake of both HIPDM (p < 0.021) and of MAA (p < 0.025) in the elastase-treated lungs indicates decrease in functioning vascular endothelium and decrease in number of pulmonary capillary vessels, respectively, reflecting damage in capillaries and small arterioles. The decrease in treated/nontreated ratios lung is consistent with a significant alteration in pulmonary function and a significant increase in mean linear intercept (p < 0.005) in treated lung. Since the imaging reflects pulmonary endothelial receptor function, [123I]HIPDM lung imaging may serve as an alternative diagnostic modality for pulmonary emphysema.

Sustained bronchodilation with isoproterenol poly(glycolide-co-lactide) microspheres

An animal study was carried out to evaluate the in vivo bronchodilator action of isoproterenol (Iso) from poly(glycolide-co-lactide) (PGL) microspheres. Microspheres with a mean diameter of 4.5 microns and a drug load of 7% were administered intratracheally to Long-Evans rats. The microspheres released about 70% of the incorporated drug in the instillation medium before administration, which provided immediate action, and the remaining 30% was available for sustained release. A total of 120 animals was anesthetized, paralyzed, artificially ventilated, and divided into 15 groups (n = 8): 3 groups each for saline, blank microspheres, free Iso, blank microspheres with free Iso, and microencapsulated Iso. All instillations were made in a volume of 1 ml/kg and the dose of all Iso preparations was 0.1 mg/kg. At 3, 6, or 12 hr after the intratracheal instillation, a serotonin challenge (40 micrograms/rat) was administered intravenously to constrict the airways. Airway function tests were performed at each time interval on one group of animals by a maximal expiratory flow-volume maneuver. The heart rate in animals receiving Iso formulations was similar to that in the saline control group, indicating minimal systemic effect of the dose administered. The systemic serum levels were below 2 ng/ml in all the groups. Animals receiving encapsulated Iso resisted the serotonin challenge for at least 12 hr after intratracheal instillation, indicating that the drug was still present over this period of time. On the other hand, the serotonin-induced airway constriction observed in the animals receiving blank microspheres, free Iso, or free Iso with blank microspheres was similar to that in saline controls at all time points. The results clearly show that only a small fraction of the free dose is required in sustained-release form for a prolonged pharmacological effect, resulting in a 50- to 100-fold reduction in the total dose administered.

alpha-Difluoromethylornithine attenuates monocrotaline-induced airway/lung dysfunction

On the basis of the previous findings that alpha-difluoromethylornithine (DFMO, an inhibitor of ornithine decarboxylase, which is the rate-limiting enzyme in polyamine biosynthesis) treatment prevents monocrotaline-(MCT) induced pulmonary hypertension and that ventilatory dysfunction precedes pulmonary hypertension in MCT-treated rats, we hypothesize that MCT-induced changes in airway/lung function are polyamine dependent. To evaluate this hypothesis, in phase 1, 48 young Sprague-Dawley rats were evenly divided into four groups: control, DFMO, MCT, and DFMO + MCT. Each DFMO rat received DFMO in its drinking water (2%) for 11 days, with additional injections (400 mg/kg sc) on the 5th day. Each MCT rat received a single injection of MCT (60 mg/kg sc) 1 wk before the functional study. Each DFMO + MCT rat received the same DFMO and MCT treatments as above, and MCT was administered on the 5th day of the DFMO treatment. In the MCT group, there were marked rightward shifts in pressure-volume and maximal flow-static recoil (MFSR) curves and significant decreases in dynamic and quasi-static compliance, the maximal expiratory flow, slope of the MFSR curve, and the carbon monoxide diffusing capacity, as well as a significant increase in alveolar wall thickness. However, in rats treated with DFMO + MCT, most of MCT-induced changes were significantly attenuated. To evaluate whether MCT causes bronchoconstriction, a bronchodilator, terbutaline (0.2 mg/kg i.v.), was administered to control (n = 7) and MCT (n = 11) rats in phase 2. Terbutaline significantly reversed MCT-induced decreases in maximal expiratory flow and slope of the MFSR curve, whereas it did not alter these parameters in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Healing of a sinus tract of periodontal origin

A sinus tract adjacent to teeth is usually considered to be of endodontic origin and root canal therapy is the primary treatment to achieve healing. A case of a sinus tract is presented in which a suspected endodontic-periodontic lesion was successfully treated by periodontal therapy alone. The sinus tract healed and the radiograph showed bony repair.

Cigarette smoke exposure does not prevent cadmium-induced alterations in rat lungs

Cigarette smoke has been demonstrated to suppress the biosynthesis of connective tissue in the lung. To further characterize this suppressant effect, we studied the ability of cigarette smoke to prevent or ameliorate cadmium-induced alterations in rat lungs in vivo. The effects of beta-aminopropionitrile (beta APN), an agent that inhibits the cross-linking of elastin, also were studied. Eighty-eight young female Long-Evans rats were randomly divided into seven groups as follows: control, cigarette smoke, sham smoke, beta APN, cadmium, cadmium + cigarette smoke, and cadmium + beta APN. Each animal in the cigarette smoke group was exposed to mainstream smoke generated from University of Kentucky 2R1 reference cigarettes (10 puffs daily for 12 wk). Sham-treated animals received room air in place of cigarette smoke. beta APN (0.5 g/kg) was injected intraperitoneally twice weekly. In cadmium-treated groups, each rat received intermittently three intratracheal instillations of cadmium chloride (0.15 mumol/kg) over a 5-d period. For the cadmium + cigarette smoke group, smoke exposure began 3 d after the first cadmium instillation and was continued for 12 wk. The beta APN administration began 5 d before cadmium instillation and also was continued for 12 wk. After these treatments, pulmonary function and lung morphometry were examined. Neither cigarette smoke, sham smoke, nor beta APN produced significant changes in lung function or morphometry. Cadmium caused significant decreases in total lung capacity, dynamic and static compliance, and carbon monoxide diffusing capacity, as well as significant increases in lung weight and alveolar wall thickness. In addition, the quasistatic deflation pressure-volume curve showed a rightward shift whereas the mean linear intercept of the alveoli did not change significantly. Efforts to prevent or ameliorate the changes through exposure to cigarette smoke or administration of beta APN were unsuccessful. It is concluded that interventions designed to inhibit the biosynthesis of lung connective tissue do not perforce inhibit the development of cadmium-induced pulmonary changes in the rat.

Nicardipine suppresses bronchoconstrictor actions of pharmacologic agents in guinea pigs

We investigated the inhibitory effects of nicardipine on airway smooth muscle constriction in the guinea pig via both in vitro and in vivo preparations. In the in vitro studies, we created dose-response curves of the excised tracheal strip. The increase in respiratory overflow produced by leukotriene (LT) D4 was measured in the in vivo preparation. In the organ bath, nicardipine (1-12 micrograms/ml) significantly inhibited constriction of the isolated tracheal spiral strip induced by 7 different agonists, acetylcholine (Ach), histamine (HA), serotonin (5-HT), prostaglandin F2 alpha (PGF2 alpha), slow-reacting substance of anaphylaxis (SRS-A), and LTC4 and LTD4. Compared to nifedipine and verapamil (data in the literature), the inhibitory potency of nicardipine on the constriction of the isolated guinea pig tracheal strip is 100-1,000 times greater. In the in vivo studies, nicardipine (50 and 100 micrograms/kg) significantly attenuated the LTD4-induced increase in respiratory overflow. These results suggest that nicardipine inhibits bronchoconstrictor-induced constriction of airway smooth muscle both in vitro and in vivo, and that it is a potent bronchodilator. The inhibitory characteristics of nicardipine may prove to be applicable clinically.

Endogenous tachykinins in antigen-induced acute bronchial responses of guinea pigs

Because tachykinins (TKs) cause severe bronchoconstriction in humans and animals, this study was carried out to examine whether depletion of TKs can prevent or ameliorate antigen-induced immediate bronchial constriction. Forty-five guinea pigs were randomly divided into six groups: control, antigen challenge, TK depletion + antigen challenge, ganglionic (Ggl) blockade, Ggl blockade + antigen challenge, and TK depletion + Ggl blockade + antigen challenge. Control animals received no treatment. Animals of all antigen challenge groups were sensitized with ovalbumin 10 days before the study. TK depletion was performed via 5-day pretreatment of capsaicin, which began 11 days before the study. On the day of the study, pulmonary resistance (RI), dynamic compliance (Cdyn), and breathing patterns were measured for 15 min just before (baseline) and for 30 min after intravenous injection of either saline (control) or ovalbumin (antigen challenge). In controls, saline injection did not produce any significant change within 30 min, whereas antigen challenge significantly increased RL at 4-15 min and significantly decreased Cdyn at 6-15 min, suggesting antigen-induced bronchoconstriction. Following TK depletion, antigen challenge produced pulmonary changes similar to those without depletion. Ggl blockade reduced RL and breathing frequency, and increased Cdyn and tidal volume; the blockade, however, did not significantly alter (in terms of % baseline) antigen challenge-induced changes in RL, Cdyn, or breathing patterns. These results suggest that TKs and reflexes via Ggl do not appear to be important contributing factors for antigen-induced immediate bronchial constriction in this animal model.