Primary malignant lymphoma of the breast. With a review of 73 cases among Japanese subjects

We report a case of a 71-year-old female with primary malignant lymphoma of the breast. The patient noticed a lump in the right breast approximately six years prior to consultation to the Surgical Department because of a rapid growth of the lump, and had no other tumors noticed throughout the body during that period. Histology proved the case to be a "reticulum cell sarcoma" (large cell type) producing IgM in the tumor cells, instead of a breast carcinoma as clinically diagnosed. At the same time, a total of 73 cases of mammary malignant lymphoma among Japanese subjects were reviewed. The criteria for primary or secondary malignant lymphoma of the breast, and histological diagnosis and pathogenesis of the primary breast malignant lymphoma were discussed.

Effects of l-carnitine on action potential of canine papillary muscle during hypoxic perfusion

Under hypoxic (95% N2 + 5% CO2) perfusion, electrophysiological effects of L-carnitine on canine papillary muscles were studied using standard microelectrode techniques. During hypoxic perfusion for 60 min, resting membrane potential (RMP), action potential amplitude (APA) and maximum upstroke velocity of phase 0 were decreased, and action potential duration (APD) and effective refractory period (ERP) were shortened. Application of L-carnitine 25 mM under hypoxic perfusion increased RMP and APA and prolonged APD and ERP significantly. As effects of L-carnitine during hypoxic perfusion might be that of hypertonicity, effects of sucrose of the same tonicity as L-carnitine were studied under hypoxia. Sucrose did not cause significant changes on various parameters of action potential compared with hypoxic perfusion. It was suggested that the increase in RMP, and the prolongation of APD and ERP might be caused by an increase in intracellular ATP content. The findings in this study could be an explanation of possible antiarrhythmic effects of L-carnitine.

Comparison of bioavailability for phenytoin products prepared by wet granulation in normal subjects and epileptic patients

A 20% phenytoin (PHT) plain mixture with excipients (20%PM) and three PHT products prepared by wet granulation, which are 20% fine granule (20%FG), 99% air-dried fine granule (99%FG-A) and 99% freeze-dried fine granule (99%FG-F), were prepared. The extents of PHT absorption from these products and the Aleviatin Fine Granules (97%FG) prepared with microcrystalline PHT powder were compared with those from commercially available PHT powder (Aleviatin) and tablet (Hydantol Tablet 25 mg), which are of the Pharmacopoeia of Japan grade, in healthy adult volunteers. In single dose study, the extents of PHT absorption from the powder, 20%PM, 20FG, 99%FG-A, 99%FG-F, 97%FG and tablet were 89.7, 92.2, 99.0, 96.7, 99.1, 99.1 and 99.3%, respectively. The property of almost complete absorption of PHT from the product was shown in the 20%FG, 99%FG-F and 97%FG similar to the tablet. In multiple dose study, the minimum and the average estimated free concentrations of PHT at steady-state for 99%FG-F and 97%FG were nearly equal to those for the tablet, and were higher than those for the powder. In epileptic patients, the plasma PHT concentrations were increased when dosage form was changed from the powder to 99%FG-F. However, the plasma PHT concentrations were scarcely altered when dosage form was changed from the tablet to 99%FG-F. The change in dosage forms from the tablet to 99%FG-F and 97%FG or opposite direction can be done without causing toxicity in epileptic patients, so long as these products are used at the same amounts as PHT.

Sleep apnea and nocturnal myoclonus in elderly persons in Vilcabamba, Ecuador

Four men (M age 90.5 years) and four women (M age 91.2 years) in Vilcabamba, Ecuador (a community noted for people with extreme longevity) volunteered for sleep recordings using four-channel Medilog portable cassette recorder. Of the eight physically healthy persons recorded, only one man displayed sleep apnea syndrome. No nocturnal myoclonus was observed. Low incidence of sleep apnea of elderly persons in Vilcabamba may be due to a low barometric pressure and/or lack of drug abuse.

Effects of L-carnitine on ventricular arrhythmias after coronary reperfusion

Effects of L-carnitine on ventricular arrhythmias and myocardial metabolism in a reperfused ischemic myocardium were studied in 35 anesthetized mongrel dogs. The left anterior descending coronary artery was ligated for 40 min and then reperfused for 15 min. L-carnitine (100 mg/kg) was administered intravenously 5 min before the coronary ligation and infused continuously at a rate of 20 mg/kg/min from 5 min before the reperfusion to the end of the experiment. Electrocardiograms were recorded continuously throughout the experiment. Transmural myocardial samples were obtained from both the ischemic and the nonischemic areas after 15 min of reperfusion and used for the determination of ATP, free carnitine, long chain acyl carnitine and long chain acyl CoA. L-carnitine significantly reduced the incidence rate of ventricular fibrillation after reperfusion (from 29% in the controls to 5%, p less than 0.05). ATP in the ischemic myocardium in the L-carnitine group was significantly higher than that in the control group (p less than 0.05). Free carnitine in the control group significantly decreased in the ischemic area as compared with the nonischemic area (p less than 0.01). In L-carnitine group, on the other hand, no difference was observed between them. Long chain acyl CoA in the control group significantly increased in the ischemic area as compared with the non-ischemic area (p less than 0.01). In L-carnitine group, on the other hand, no difference was observed between them. Thus, the accumulation of long chain acyl CoA in the ischemic myocardium was reduced by the L-carnitine treatment. These data suggest that L-carnitine has protective effects on ventricular arrhythmias and on metabolic changes after coronary artery reperfusion following coronary artery occlusion.

Bioavailability of phenytoin on single and multiple oral doses of two dosage forms in normal subjects

The extent and rate of absorption of phenytoin (PHT) from tablet and powder were studied in four healthy adult volunteers. It was demonstrated by urinary and fecal excretion that the almost all quantity of PHT in tablet was absorbed through the gastrointestinal tract, and the observed values of the estimated free concentration (Cest.f) estimated from mixed saliva concentration of PHT in the multiple dose were in fair agreement with the calculated values of that by using computer simulation in case of tablet. On the contrary, the variations were observed in Cest.f using therapeutic dose of PHT powder. The values of Cest.f at steady-state in tablet administration were higher than those in powder administration. The absorption ratio of PHT powder was low and variable, and decreased upon increase of dose. The ratio calculated from the Cest.f values of both dosage forms at steady-state were in good correspondence to the observed values of PHT excreted in feces.

Estimation of plasma unbound phenobarbital concentration by using mixed saliva

Relationships among plasma total (Ct), plasma protein unbound (Cf) and mixed salivary (Cs) concentrations of phenobarbital (PB) were studied in 29 epileptic patients. A highly significant correlation was observed between Ct and Cf. Although a significant correlation was observed between Cf and Cs, Cs/Cf ratio was only 0.63. When Cs was corrected by using pKa (7.41) and pH of saliva to estimate free PB concentration (Cest f), a highly significant correlation was obtained between Cf and Cest f, and Cest f/Cr ratio was 0.96. The temporal course of Cest f obtained from Cs after an oral single dose of 50 mg PB in a healthy adult male volunteer was approximated as a triexponential equation. The peak time was 2 hr after ingestion and apparent half life was 66 hr. The prediction of minimum concentrations at steady state on the basis of these parameters corresponded well with actually obtained Cest f following repetitive administration of PB.

Three-dimensional architecture of blood vessels of tendons demonstrated by corrosion casts

Three-dimensional observation of the microcirculation of the tendon was readily and clearly demonstrated by preparing methyl methacrylate casts and observing them under the scanning electron microscope. In the muscles blood vessels made a network like a ladder surrounding every muscle fibre. The fibrous digital sheath had blood vessels made in a fine meshed cylinder. By microdissection of the vessels of the sheath the blood vessels of the vinculae and tendons were observed stereoscopically in relation to the peritendinous tissues. The casting method contributes to better understanding of vascular architecture of tendons.