Influence of induced cholestasis on pharmacokinetics of digoxin and digitoxin in dogs

Dogs with ligated common bile ducts were used to determine effects of cholestasis on pharmacokinetics of digoxin and digitoxin. Forty-three dogs were assigned to: group 1--sham-operated controls (n = 13); group 2--dogs with ligated common bile duct (n = 17); group 3--dogs given phenobarbital for 2 weeks before common bile duct was ligated (n = 11); or group 4--dogs with an induced biliary fistula (n = 2). Digoxin (group A) or digitoxin (group B) was given as single IV injections, and digitalis concentration in plasma was measured by radioimmunoassay. In 18 dogs given digoxin, differences in plasma digoxin concentrations among groups 1A to 3A were not significant (P greater than 0.1). Plasma elimination rate of digoxin was delayed in group 2A. Group-3A dogs had a shortened beta phase half-life (t1/2 (beta] and a decreased distribution volume. In 25 dogs given digitoxin, group-2B dogs maintained a significantly higher plasma digitoxin concentration (P less than 0.01) and had a significantly longer t1/2 (beta] than did dogs in groups 1B and 3B (P less than 0.05). In group-3B dogs, plasma digitoxin concentration was decreased and t1/2 (beta] of digitoxin was shortened. In 10 group-B dogs given 3H-digitoxin (groups 1B, 2B, and 4B), the excretion of total radioactivity in urine and bile was 15 to 20 and 7% of the dose, respectively in the first 24 hours. Most radioactivity in urine and bile was a dichloromethane-unextractable fraction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Manometric study of vertical banded gastroplasty for morbid obesity]

Morbidly obese patients undergoing vertical banded gastroplasty were studied preoperatively and/or postoperatively to characterize its manometric pattern. The esophageal manometry using station pull through technique involved 14 preoperative patients with a mean age of 28 +/- 7 years who were a obesity index of 220 +/- 32% and 14 postoperative patients with a mean age of 30 +/- 7 years who were a obesity index of 158 +/- 23%. Preoperative lower esophageal sphincter (LES) pressure using gastric base line as O was 16.1 +/- 8.5 cmH2O and a LES length of 3.4 +/- 0.9 cm. Postoperatively, the vertical banded gastroplasty channel had a pressure of 17.7 +/- 7.1 cmH2O and a length of 8.2 +/- 1.7 cm which was higher than gastric base line. No difference was seen between preoperative LES pressure and postoperative channel pressure, however postoperative channel length was significantly (p less than 0.01) larger than preoperative LES length. We concluded that vertical banded gastroplasty for morbid obesity created a longer high pressure zone in accordance with channel which would inhibit reflux of gastric juice.

Measurement of 5'-methylthioadenosine in patients with neoplasms

The amount of polyamines in urine from patients with various neoplasms is larger than in normal subjects. We have determined the concentration of 5'-methylthioadenosine (MTA), a by-product of the polyamine biosynthesis, in patients with malignancies as well as normal subjects. Our studies indicate that the amount of MTA in urine from patients with leukemias and malignant lymphomas was higher than in normal subjects (p less than 0.005). Urine samples from patients with other malignancies contained normal amounts of MTA. The levels of blood MTA in patients with leukemias before treatment or in relapse was higher than in control subjects (p less than 0.005), while in patients with other malignancies and leukemia in remission, the levels were not different from control subjects. Peripheral blood MTA levels clearly decreased after effective chemotherapy. The measurement of MTA levels in urine and blood may not be as useful as polyamine assays for the detection of malignancies, but blood levels of MTA may be useful as an indicator of the efficacy of chemotherapy in leukemic patients.

[Clinical effects and plasma concentration levels of aprindine hydrochloride in patients with tachyarrhythmias]

Aprindine hydrochloride (aprindine) was administered orally in 17 Japanese patients with supraventricular or ventricular tachyarrhythmias, and the clinical effects and plasma concentration levels were evaluated. The antiarrhythmic effects were defined using Holter ECG recordings. Aprindine was administered orally with a daily dose of 40 mg for 2 weeks in all cases, and aprindine, 60 mg daily, was administered for the next 2 weeks in patients who did not show sufficient antiarrhythmic effects with 40 mg of the drug. Aprindine was effective in 9 of 17 patients, and the mean plasma concentration level reached 0.6 micrograms/ml 2 weeks after the administration was started. Effective results were seen in 2 of the 4 patients receiving a daily dose of 60 mg, and the mean plasma concentration level reached 1.0 microgram/ml 2 weeks after the administration was started. Transient mild elevations of liver transaminases were observed in one patient and mild transient anemia was observed in another. These abnormal data disappeared although the drug administration was continued. In conclusion, the administration of a relatively small dose of aprindine and, consequently, low plasma concentration levels, are effective for cardiac tachyarrhythmias in Japanese patients.

[Clinical characteristics of unstable angina in 162 consecutive cases]

We surveyed the clinical characteristics, treatment, and prognosis of 162 patients with unstable angina, who were admitted to our center between 1985 and 1987. There were 112 males and 50 females, with a mean age of 65 years. The clinical characteristics according to the American Heart Association classification were new angina of effort in 21%, changing pattern in 61%, and new angina at rest in 18% of the patients. ECG recordings during attacks of angina were obtained in 70%, and ST elevation was detected in 11%, ST depression in 54%, and T wave abnormality in 5%. Coronary arteriography performed in 42% of the patients revealed single vessel lesion in 21%, two vessel lesion in 10%, three vessel lesion in 5%, and left main trunk lesion in 3% of the patients. Seventy-seven percent of the patients were controlled by medical therapy, including nitrates, calcium antagonists, and, in some cases, beta blockades. Three percent of the patients were controlled with intra aortic balloon pumping in addition to medical therapy. Coronary artery bypass graft surgery (CABG) was performed in 6% of the patients. Since 1987, percutaneous transluminal angioplasty (PTCA) was introduced in our center and PTCA was performed in 9 patients (6%). Restenosis of the dilated portions of the coronary artery was observed and PTCA was again performed in 2 of 9 patients (22%). All patients who received CABG or PTCA survived and have been free from angina or myocardial infarction. Non-fatal myocardial infarction occurred in 10 cases (5.6%) and fatal infarction occurred in one patient (0.6%).

In situ distribution of enolase isozymes in chronic liver disease

Liver biopsy specimens with or without chronic liver diseases were examined immunohistochemically to determine the distribution of enolase isozymes (alpha, beta, and gamma). In normal liver, alpha-enolase was positively stained in almost all hepatocytes and bile duct cells. beta- and gamma-enolases were localized in hepatocytes and bile duct cells, respectively. Electron microscopic studies revealed that Kupffer cells and sinusoidal endothelial cells had both alpha- and gamma-enolases. In chronic active hepatitis and cirrhosis, proliferated biliary ductular cells had both alpha- and gamma-enolases, but did not express beta-enolase. This is almost the same localization pattern of enolase isozymes as in preexisting bile duct cells. gamma-Enolase was detected in some hepatocytes in eight of 12 cases with chronic active hepatitis and six of 12 cases with cirrhosis. These hepatocytes were small, showed a cobblestone pattern, and binucleate cells were frequent. On the other hand, rosette-formed hepatocytes adjacent to a regenerating bulging lobule were not stained for gamma-enolase. These results suggest that regenerating hepatocytes have gamma-enolase and that, with maturation, hepatocytes lose it.

[A case of mitral stenosis with left atrial thrombus arose and reduced in a short-term]

A case of mitral stenosis with left atrial thrombus which rapidly arose and reduced within a month was reported. A 61-year-old female was admitted to our hospital on November 14, 1986 because of a syncopal attack due to ventricular tachycardia. On admission she had typical auscultatory signs of mitral stenosis, mild hepatomegaly and no neurological abnormality. Laboratory findings included coagulation studies were normal, and atrial fibrillation was noted on ECG. Heart catheterization revealed low cardiac output, the mitral orifice area to be 2.4 cm2 and left ventriculography showed mild mitral regurgitation. Ventricular tachycardia was controlled following improvement of heart failure. On two-dimensional echocardiography performed on December 24, left atrial thrombus was revealed which was not detected on December 3. Through the continuous administration of warfarin and aspirin to prevent the thrombus' growth, it markedly reduced in size, from 3 x 2 x 4.5 cm on December 24, 1986 to 1.5 x 1 x 2.5 cm on January 30, 1987 without systemic embolism. Then a mitral valve replacement and a left atrial thrombectomy were performed on February 3, with the removal of a red thrombus, partially organized, measuring 1 x 0.7 x 2.5 cm. This case is unique in its clinical outcome and further investigation is necessary for the management of patients as our case.

[Correlation between subgingival microflora and peptidase activity in periodontal pockets measured with synthetic substrates]

The activity of peptidases in periodontal pockets of patients were examined by using four different synthetic enzyme substrates, and surveyed their correlation with the microbial populations of subgingival plaque and clinical symptoms. The substrates were (1) alpha-N-benzoyl-DL-arginine-beta-naphthylamide (BANA), (2) N-carbobenzoxy-glycylglycyl-arginine-4-methoxy-beta-naphthylamide, (3) alpha-N-benzoyl-L-arginylglycyl-L-phenylalanyl-L-proline-4-methoxy -beta-naphthylamide and (4) N-carbobenzoxy-prolyl-L-alanylglycyl-L-proline-4-methoxy-beta naphthylamide. Whereas substrates (1) and (2) were hydrolyzed more specifically by peptidases of mainly Bacteroides gingivalis and Treponema denticola, substrates (3) and (4) were susceptible to most of the strains of black-pigmented Bacteroides, Capnocytophaga and T. denticola. Correlation between the peptidase activity and the level of Spirochetes in the plaques were observed with the substrates (1), (2) and (3). Substrate (3) had the strongest correlation also with the level of the black-pigmented Bacteroides and with the depth of the periodontal pockets, suggesting that it is a better substrate for enzymatic diagnosis than BANA which is currently used as an indicator of oral Spirochetes and the black-pigmented Bacteroides.

Effect of histamine H1-receptor antagonist on the regulation of carbohydrate and lipid metabolism in rat liver

In order to elucidate the role of histamine in the liver, we studied the effect of a histamine H1-receptor antagonist on the carbohydrate and lipid metabolism in the rat liver. The administration of the H1-receptor antagonist decreased significantly the contents of glycogen and malonyl-CoA in the liver. However, it did not affect the levels of serum glucose and free fatty acid. These results suggest that histamine may play a part in the regulation of metabolism of carbohydrates and lipids in the liver.

[Introduction of a method of promoting periodontal disease awareness]

In periodontal diseases, due to lack of subjective symptoms, disease awareness and professional consultations are often dismissed even by subjects with already established periodontal lesions. The purpose of this study was to gain data concerning the relationship between bleeding induced by interdental stimulating and some of the clinical indices used in routine periodontal examinations in order to consider if wooden interdental cleaners, which are available to patients themselves, could be used as a means of arousing disease awareness. Furthermore, the buccolingual insertion of interdental cleaners was confirmed together with reconsiderations on its role as a means of proximal plaque control. 180 interdental sites of 30 new out-patients suspected of gingivitis or periodontitis consisted the material. As comparative indices to interdental stimulating, Bleeding on Probing (BOP), Probing Depth (PD), Gingival Index (GI) and Gingival Crevicular Fluid (GCF) measurement were selected. The interdental cleaning efficiency was reconsidered by assessment of interproximal plaque removal. As a result, bleeding was induced both by interdental stimulating and probing in 106 of the 180 experimental sites and was the majority. In relation to PD, concerning pockets less than 1.5 mm, bleeding was not induced by interdental stimulating. 58.8% of 3 mm pockets and all of the pockets deeper than 5 mm bled on interdental stimulating. Concerning the relationship with the GI, no site evaluated GI. 0 bled on interdental stimulating. 12.9% of sites evaluates GI. 1, 73.3% of sites evaluated GI. 2, and all of the sites evaluated GI. 3 bled on interdental stimulating. 39.0% of sites with GCF measurement of 0-21, 51.9% of sites with GCF measurement of 21-40 and 96.8% of sites with GCF measurement of over 81 showed bleeding on interdental stimulating.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunohistochemical studies on the distribution of nerve fibers in chronic liver diseases

Innervation of the liver with or without chronic liver disease was immunohistochemically studied. In normal liver tissues, gamma-enolase [neuron-specific enolase (NSE)]- and S-100 protein (S-100)-positive nerve fibers were found around hepatic arteries, portal veins, and bile ductules in the portal area, along the sinusoid, and around central veins inside the hepatic lobule. Neuropeptide Y (NPY)-immunoreactive (IR) nerve fibers were detected in close contact with hepatic arteries and portal veins in the portal area and along the sinusoid in the parenchyma. Vasoactive intestinal polypeptide (VIP)-IR nerve fibers were found in the portal area but were scarce in the parenchyma. VIP-IR nerve fibers were much fewer than NPY-IR fibers. In patients with chronic active hepatitis, NSE- and S-100-positive nerve fibers, as well as NPY-IR nerve fibers, proliferated in the enlarged portal area. In cirrhotic liver, NSE- and S-100-positive nerve fibers and NPY-IR fibers increased remarkably in the fibrous septa, whereas they decreased or vanished inside the pseudolobules. These findings suggest that, in chronic liver disease, intrahepatic nerve fibers change their distribution, accompanying the structural changes in the hepatic lobules.

Kawasaki disease complicated with mitral insufficiency. Autopsy findings with special reference to valvular lesion

A case of mucocutaneous lymph node syndrome (Kawasaki disease, MCLS) complicated with mitral insufficiency is reported. This patient showed severe valvulitis, which was thought to be the main cause of mitral regurgitation. Two other patients with MCLS who did not present clinical signs of mitral insufficiency revealed the presence of mild valvulitis. The morphological alterations of cardiac valves were non-specific and mainly consisted of inflammatory infiltration, increment of fibrous connective tissue, and proliferation of small capillaries. In addition to the coronary aneurysms, the involvement of cardiac valves should receive attention as the sequelae of MCLS.

Magnesium cation induced conformational change of yeast tRNAPhe as studied by singlet-singlet energy transfer

The A76 or A73 nucleotide at the 3'end of tRNAPhe was modified with the fluorescent reagent of proflavine (PF). The distance between the fluorophore of the 3'end and the Y base was measured by singlet-singlet energy transfer under the conditions of 10 mM and 0.01 mM Mg2+. The distance obtained at 10 mM Mg2+ is very close to that obtained by the X-ray diffraction method, while the distance at 0.01 mM Mg2+ is significantly smaller. The difference in the distance is explained as a result of destabilization of the tertiary structure with reduction of the Mg2+ concentration. The calculated distance between A73 and A76 shows the stacked conformation of the CCA strand. Fluorescent quenching experiments showed that the degree of stabilization of 3'end A76 by stacking is lower than that of A73. The removal of the CCA segment causes a difference not only in the thermal melting curves but also in the fluorescent wavelength of the Y base at 0.01 mM Mg2+. The results suggest that the 3'end CCA strand has a helical structure and contributes to the stabilization of the whole structure of tRNAPhe.

Partial melting of the segment around pseudouridine in yeast 5S RNA

Pseudouridine in yeast 5S RNA was modified with 4-bromomethyl-7-methoxy-coumarin(BMC). Temperature dependence of fluorescence intensity was measured at various concentrations of Mg2+ and K+ cations. Hyperchromicity was also measured. At 100mM KCl and 10mM Mg2+, fluorescence intensity decreased with temperature as free BMC except a plateau at 45 degrees C. Withdrawal of Mg2+ from the buffer resulted in a large quenching at 20 degrees C and showed a gradual increase of fluorescence intensity with temperature, indicating a partial melting of the segment around pseudouridine. The temperature range agrees with the low melting temperature shown by hyperchromicity. In 10 mM KCl solution, the effects are more exaggerated.

[Successful treatment in an adult case of congenital esophagobronchial fistula]

A case of congenital esophagobronchial fistula in a 46-year-old woman was described. The patient had presented with repeated attacks of pulmonary infection from her childhood and had been diagnosed pneumonia at least five or six times after the age of 18 years. Preoperative examinations including esophagogram by barium swallow revealed the existence of a fistula between middle thoracic esophagus and left B6 bronchus. The fistula was recognized as Type II of Braimbridge and Keith's classification, and successfully resected with left lower pulmonary lobe. Sixty-eight cases with congenital esophagobronchial fistula in adult including our own case have been reported in Japanese literature and about 70 cases in the literature of western countries. From the analysis of these cases, diagnostic basis on congenital origin of the fistula, useful diagnostic methods, types of the fistula and appropriate surgical procedures were discussed.

Optical stabilizer using a bistable optical device with a PMN electrostrictor

An optical stabilizer utilizing the higher-order stable state of a Fabry-Perot resonator bistable optical device has been made using a PMN electrostrictor with a high bias voltage. The output power of this device exhibits bistable behavior with high reproducibility and is nearly constant over a wide range of input power. Light intensity fluctuation of the laser source can be reduced to ~1/150 by using this optical stabilizer.

Pre- and postoperative arrhythmias in congenital heart disease: from the results of surgery using surface-induced deep hypothermia

The incidence of arrhythmias in 3614 preoperative patients with congenital heart disease was 1.6 per cent. Pre- and postoperative serial ECGs in 186 patients with an isolated VSD and in 58 patients with TOF were reviewed. The incidence of CRBBB and CRBBB-LAH following VSD repair was 33% and 6.6%, respectively, and for TOF was 55% and 5.2%, respectively. Complete A-V block (CAVB) was seen in 2 patients following VSD repair, and none of TOF patients developed CAVB. Late cardiac or dysrrhythmic death was not recognized in our limited follow up period. The indications for surgery in membranous VSD should be determined more carefully, because the risk of the surgical damage to the conduction system is still higher. Moreover, we must keep in mind that damage to the A-V conduction system may occur naturally even in a patient with small VSD. Finally, it can never be overemphasized that physicians must pay attention to the occurrence and course of postoperative arrhythmias.

Stimulation of immunoreactive somatostatin release from hypothalamic synaptosomes by high (K+) and dopamine

Effects of high (K+) and dopamine on the release of immunoreactive somatostatin from isolated hypothalamic synaptosomes were studied in rats. High (K+) (60 mM) and dopamine (10(-6) M) in the incubation media stimulated the release of immunoreactive somatostatin and the former effect was completely abolished by the removal of Ca++ from the media. These suggest that hypothalamic somatostatinergic synaptosomes preserved at least one of the important basic properties of secretory cells. Although it is of interest to note that dopamine stimulated the release of somatostatin. Its physiological significance awaits further studies.

Conformational changes and reassociation properties of small subunits of Escherichia coli ribosomes

Studies on the reassociation of ribosomal subunits from Escherichia coli were carried out using an ultracentrifuge equipped with a UV absorption scanner, and the conformational changes of ribosomal subunits were followed by circular dichroism measurements. Reassociation between the fractionated 30S and 50 S subunits was promoted by the addition of uncharged tRNA at 4 degrees. Furthermore, a sharp increase in the amount of reassociated products was observed on treatment of the sample solution at temperatures above 25 degrees. Treatment at higher temperature only affected 30 S ribosomal slbunits. From CD measurements of Mg2+ concentration dependence for both ribosomal subunits, a significant decrease in molar ellipticity [theta] at the 264 nm positive peak and a slight change of [theta] at the 222 nm band were observed for both subunits in dissociation buffer. Samples of 30 S subunits pretreated at 37 degrees for 40 min showed a small CD change at the 222 nm band. The same samples showed a slight increase in S value and enhanced ability to form 70 S particles with 50 S subunits. On the other hand, we detected no significant changes in CD spectra, S value or the ability to form 70 S particles with 50 S ribosomal samples subjected to same heat treatments.