[The treatment of accompanied organ failure after thoracic and cardiovascular surgery with mechanical organ-supports]

Five hundred and thirty-three patients have been treated after thoracic and cardiovascular surgery in our ICU during the last four years. Cardiac failure was shown in 150 cases, respiratory failure in 132 cases, renal failure in 76 cases, and hepatic failure in 84 cases. The appropriate mechanical organ-supports (MOS) were applied in the following cases: intra-aortic balloon pumping (IABP) in 48 cases, veno-arterial bypass (VAB) in 18 cases, left ventricular assist device (LVAD) in 1 case, respirator in 132 cases, continuous hemofiltration (CHF) in 44 cases, hemodialysis (HD) in 13 cases, peritoneal dialysis (PD) in 21 cases, Continuous intensive peritoneal dialysis (CIPD) in 7 cases, and plasma exchange (PEx) in 22 cases. The results of MOS6 which required exocorporeal circulation were not satisfactory, especially CHF (mortality rate 75.0%), HD (76.9%), and VAB (100%). Though, the results of IABP (35.4%) and CIPD (14.3%) were significantly better. The main cause of early death (within 6 post-operative days) was low output syndrome (LOS) (63.6%). However, that of late death (beyond 14 post-operative days) was sepsis (66.7%). Therefore, it is important for the survival of these patients to control LOS during the early post operative period and then to concentrate on the prevention of infection.

Angiotensin-converting enzyme inhibitors: synthesis and structure-activity relationships of potent N-benzyloxycarbonyl tripeptide inhibitors

A new series of gamma-D-Glu-containing N-benzyloxycarbonyl (Z) tripeptide inhibitors of angiotensin-converting enzyme (ACE) was synthesized. The effect of varying the antepenultimate amino acid residue in this series on the biological activity was studied. Introduction of Lys and Orn residues at the P1 position provided the most potent inhibitors, 25a and 25b (IC50: 3.5 and 4.9 x 10(-9) M, respectively), which exhibited an oral antihypertensive activity. This result suggests that basic amino acid residues at the P1 position play an important role in binding with the S1 subsite of ACE in this series. Oral antihypertensive activity of selected compounds was evaluated.

[A case report of emergency thoracotomy and aortic cross clamp for massive abdominal hemorrhage due to the rupture of a pancreatic pseudocyst]

The authors present a rare case of a 58-year-old female who had cardiac arrest due to massive abdominal hemorrhage because of the rupture of pancreatic pseudocyst during an emergency operation. We succeeded in resuscitation by performing emergency thoracotomy and internal cardiac compression. Thoracic aortic cross clamping was employed to control bleeding, and we could perform the operation. She recovered without any neurological deficits. Thoracic descending aortic cross clamping should be always considered both before and during operation for the control of massive abdominal hemorrhage to avoid circulatory collapse.

[Surgical management of acquired tricuspid valve disease--the effects and comparison of tricuspid annuloplasty (De Vega) and tricuspid valve replacement]

A total of 92 patients with tricuspid valvular disease (TR) had surgical repair of DeVega's annuloplasty in 80 patients (87%) and of valve replacement in 12 patients (13%) from January, 1978, to March, 1988. All of those patients were diagnosed by cardiac catheterization and angiogram, clinical findings and in recent cases, pulsed and color Doppler echocardiography were applied. Eighty-nine of 92 patients (97%) were in NYHA class III or IV before operation. There were 7 early death (8.5%) with DeVega procedure and one death (8.3%) in TVR and late deaths were noted in 3 patients (3.6%) (DeVega's procedure) and one (8.3%) in TVR. Two patients after DeVega procedure at 5 and 6 years were required re-operation of TVR because of recurrent mitral valvular disease. Seventy-seven of 80 survivors were in NYHA class I or II postoperatively. Twenty-seven randomized selected patients after DeVega's annuloplasty were investigated by pulsed and color Doppler echocardiography, 17 of them (63%) had no regurgitation and the remaining 10 patient had mild to moderate regurgitation. This study suggests that DeVega's annuloplasty has a simple and reliable procedure in patients with functional TR and results in excellent hemodynamic and functional effects postoperatively.

The thrombolytic effects of native tissue-type plasminogen activator (AK-124) on experimental canine coronary thrombosis

To evaluate the thrombolytic effects of the native tissue-type plasminogen activator (t-PA), the authors used a thrombus model simulating clinical situations. The native t-PA (AK-124) was obtained from human-derived normal cells. Experimental canine coronary thrombosis was produced by partial constriction and endothelial denudation of the vessel. In 19 dogs, coronary occlusive thrombus was produced. Three hours after total occlusion of the coronary artery with thrombus, the authors attempted the thrombolytic therapy in 16 dogs. Histologically, three-hour thrombus was composed of a mixture of platelet aggregates, fibrin, and blood cells. They infused 0.375 mg/kg t-PA intravenously in 7 dogs and 20,000 IU/kg urokinase (UK) in 9. Coronary recanalization was achieved in 5 (71%) with t-PA infusion and 6 (67%) with UK infusion. Plasma fibrinogen levels decreased to 76% of preinfusion value in the dogs with t-PA infusion and to 34% in those with UK infusion. Coronary reocclusion occurred in 2 dogs with t-PA and 3 with UK. Thus, the native t-PA (AK-124) can provide coronary thrombolysis without severe depletion of plasma fibrinogen levels.

Enhancement of arterial thrombolysis with native tissue type plasminogen activator by pretreatment with heparin or batroxobin: an angioscopic study

The enhancement of canine arterial thrombolysis with native tissue type plasminogen activator (nt-PA) obtained from human-derived normal cells by pretreatment with heparin or the defibrinogenating agent, batroxobin, was evaluated with angioscopy. The nt-PA, 0.25 mg/kg, was infused intravenously to lyse 1-hour-old thrombus (eight thrombosed arteries without medication, seven with nt-PA alone, seven with nt-PA and heparin, and seven with nt-PA plus batroxobin). Angioscopy provided a cross-sectional view of the vessel lumen with clear visualization of the thrombus. Thirty minutes after nt-PA infusion, the percent luminal obstruction decreased from 74 to 61 in nt-PA alone (p less than .025), from 77 to 37 in nt-PA plus heparin (p less than .005), and from 79 to 25 in nt-PA plus batroxobin (p less than .005). Fifteen minutes after drug infusion, plasma fibrinogen levels decreased to 89% of preinfusion value in nt-PA alone, to 84% in nt-PA plus heparin, and to less than 5% in nt-PA plus batroxobin. Thus rapid infusion of nt-PA alone provided slight thrombolytic effects. However, heparin and batroxobin showed marked enhancement of thrombolytic effects of nt-PA.

[An immunohistochemical study of endogenous estradiol and testosterone in human colo-rectal cancer tissues]

An immunohistochemical method (peroxidase antiperoxidase method) was carried out to examine the distribution of endogenous estradiol (E2) and testosterone (Te). One hundred and twenty four (48.2%) of 257 colo-rectal cancer cases, and 36.7% of male cases and 58.4% of female cases revealed E2-immunostain. This immunohistochemical reaction for E2 was found more frequently in female patients than in male patients, while Te-immunostain was found in 15 (17.6%) of 85 colo-rectal cancer cases. E2 and Te were demonstrated mainly in the cytoplasms and occasionally in the nuclei of cancer cells. Since E2 or Te-positive cancer cells were mainly distributed in the deeper or invasive portion of tissue sections, it might deserve further investigation to elucidate a certain relationship between cancer growth and endogenous sex-hormones.

Pathogenesis of water-immersion stress-induced gastric ulcers in rats with renal failure

Rats with or without renal failure, produced by uranyl acetate, were subjected to water-immersion stress for 6 h. The severity of stress-induced gastric ulcers in the renal failure group was significantly higher than that in the control group. The intragastric pH did not significantly differ between the two groups. Transmucosal electrical potential difference, gastric mucosal blood flow, and gastric mucosal hexosamine content in the renal failure group were significantly lower than in the control group. These results suggest that decreases in defensive factors, rather than an increase in an aggressive factor, may be more closely involved in the development of acute gastric ulcers in rats with renal failure.

Experimental studies on the pharmacokinetics and therapeutic effect of cefbuperazone in biliary infection

A study was carried out using an experimental biliary infection model to investigate the pharmacokinetic characteristics and therapeutic effect of cefbuperazone in the rabbit. Thirty rabbits were divided into three equal groups; a control group of normal animals, a group of infected animals receiving no cefbuperazone, and a group of infected animals receiving 50 mg cefbuperazone/kg intramuscularly. The experimental infection was made by direct inoculation of a suspension of E. coli into the common bile duct after ligation. The results showed that extremely high levels of cefbuperazone were achieved in bile and tissues of the biliary tract and were higher than those in the blood. Moreover, the levels were maintained at effective concentrations even after 6 hours. Viable bacterial cells from bile and the gall-bladder were barely detectable 24 and 48 hours after infection in the cefbuperazone-treated group, whilst counts remained high in the other infected group. White blood cell counts were increased at 24 hours after infection but were significantly lower in the cefbuperazone-treated group. Histological examination revealed marked inflammatory changes in the gall-bladder and bile duct of infected, untreated animals but few, mild changes only were seen in cefbuperazone-treated animals. Similarly, total bilirubin and liver enzymes were markedly increased in infected animals, but transaminases and alkaline phosphatase were significantly lower in the treated compared to the untreated group. The findings indicate, therefore, that cefbuperazone can be a useful antibiotic in biliary infection.

[Diagnosing the depth of esophageal carcinoma invasion by esophagography scoring]

In patients with an esophageal carcinoma, it was important to determine the depth of the carcinomatous involvement so as to decide on its resectability and prognosis. Thus four measurements of the esophagography findings involving ninety five post-esophagectomy patients were categorized into four grades and scored from point 1 to point 4, depending on the degree of severity, the measurements being the size of the tumor, the circumferential carcinomatous invasion, the degree of stenosis, and the depth of the ulcer. The sum total scores of these four esophagography findings were found to correlate well (P less than 0.01) with the depth of the invasion (submucosa, muscularis propria, adventitia, and the adjacent structures).

Isolation and identification of prostaglandin I 2 stimulating factor from human plasma

To isolate and identify the plasma factor which stimulates prostaglandin I 2 production by rat aortic ring, a human plasma fraction which showed a major stimulating activity on prostaglandin I 2 production was purified by ultrafiltrate, Sephadex G-10 gel filtration and QAE-Sephadex column chromatography. The purified plasma factor was identified as uric acid by its ultraviolet and infrared absorption spectroscopy, and 1H nmr and 13C nmr spectroscopy. The stimulating activity of the purified plasma factor and that of authentic uric acid coincided with each other. The stimulating potency of uric acid at its physiological concentration in human plasma (about 50 micrograms/ml) was half of the deproteinized human plasma, and was about 30 fold stronger than that of L-tryptophan, a cofactor of prostaglandin hydroperoxidase.

[Cooperative research on post-operative adjuvant therapy of breast cancer. Tohoku Society of Adjuvant Chemo-endocrine Therapy of Breast Cancer]

A randomized trial was carried out in 55 institutes in the Tohoku district to examine the significance of breast cancer post-operative adjuvant chemo-endocrine therapy in stage II and IIIa patients for possible radical mastectomy. A total of 619 patients were entered from November 1982 to November 1984, of whom 554 were eligible. Patients were administered MMC 13 mg/m2 after surgery, and randomized using the envelope method into either group A, treated with Tegafur 400 mg/m2 alone (275 patients), or group B, treated with Tegafur 400 mg/m2 and Tamoxifen 20 mg/daily (279 patients), for a year from the 7th day after operation. There was no significant difference between the two groups in the background factors of age, menopausal status, operation methods, stage or number of positive lymph nodes, but there were more patients of ER(+) in group B. A Kaplan-Meier method comparison showed no significant difference between the two groups in 3-year disease-free survival rates. There was no significant difference between the two groups compared by ER or menopausal status. However, patients with 4 or more positive lymph nodes showed a significant benefit in group B. Group B also marked a higher disease-free survival rate for ER(+) patients with 4 or more positive lymph nodes.

[Pulmonary dirofilariasis found unexpectedly during thymectomy]

A 56-year-old woman in Kitakyushu City was operated on after diagnosis of mediastinal tumor with myasthenia gravis. Besides the thymoma, a small nodule was palpated in the lower lobe of the left lung and biopsied. A segmented worm was found in sections of this granulomatous nodule. A cross section of the degenerated worm (400 X 310 micron) showed a 3-layered tegument and internal cuticular ridges with high lateral chords. The muscle layer consisted of high and polymyarian muscles. Based on these characteristics, this worm was identified as an immature dog heartworm, Dirofilaria immitis. The recent sharp increase of dirofilariasis cases reported in Japan is discussed.

[A case of small cell carcinoma of the esophagus]

The case of a 51-year-old man, complaining of a sense of pressure on his chest, is reported. Tests led to a diagnosis of a cancer in the midesophagus and a subtotal esophagectomy was performed. The tumor was found to be a protruded type, 8.5 X 7.0 cm in size. A histologic diagnosis revealed it to be a small cell anaplastic carcinoma. The tumor cells were found negative in a Grimelius staining and did not contain hormones such as ACTH. Some cytokeratins, however, were detected by an immunohistochemical examination, Cancer invasion into the adventitia was seen, though no lymph node metastasis or a distant metastasis was shown. Six months after operation, a recurrence in the mediastinum and in the distant lymph nodes was found. Chemotherapy and irradiation were found to be useful, and the postoperative survival period was 25 months.

[A case report of nasal infestation by the leech, Dinobdella ferox]

A 55-year-old man in Okagaki Town, Fukuoka Prefecture, pulled a nasal leech from his nostril in July 1987, after suffering from nosebleed, copious running snivels as well as unpleasant foreign body sensation in the nasal cavity. Except for nasal septum deviation, no abnormality in the ears and mouth cavity nor bleeding, ulcerous and erosive changes in the nasal cavity were found. The formalin-fixed specimen of the leech was nearly black with no definite stripes or spots, and measured 3.5 cm in length and 1.2 cm in width. Because of these and the following characteristics, viz. 1) auricles on the posterior segment were absent, 2) five pairs of eyes were present in the anterior segments with the eye pairs 3 and 4 separated by an annulus, and 3) teeth were not observed, this specimen was identified as Dinobdella ferox. This nasal leech is found widely in Southeast Asia. In Japan, some human cases of its infestation have also been reported, mainly from southern Kyushu. The leech seemed to have entered the nasal passage of the present case from a stream at a hot spring in northern Kyushu. Attention should be given to nasal leech infestation especially now that many people in Japan are eager to visit isolated hot spring resorts.

[Three recent cases of ascariasis in northern Kyushu]

Ascariasis is considered to be one of the rare infectious diseases in Japan, but recently it has been slightly increasing. This paper reports three ascariasis cases who seemed to be infected recently in the Kitakyushu area, Japan. Case 1: A 59-year-old woman in Kitakyushu City passed a round worm after continuous abdominal pain. The patient was discharged from the hospital because of no further abnormal intestinal symptoms and findings. Case 2: An 85-year-old woman in Nakama City, who suffered from cerebral infarction, vomited a round worm before hospitalization. Many ascarid eggs were detected after admission, and after treatment with pyrantel pamoate (Combantrin) two round worms were passed and egg detection became negative. Case 3: A 77-year-old man in Saikawa Town vomited 3 round worms after gastrectomy due to early gastric cancer. Many unfertilized eggs were also detected from the stool together with hook worm eggs, but no eggs were found after administration of pyrantel pamoate. Morphological examination was made by a scanning electron microscope on the denticles on the dentigerous lip ridges of the worms to differentiate from possible infection with a pig parasite, Ascaris suum. The three cases were diagnosed as ascariasis due to human Ascaris lumbricoides based on the following evidences that the expelled worms had 1) less pointed tips of the denticles and shallower or wider interdenticle notches, and 2) far more denticles of smaller size along the dentigerous ridges, compared with Ascaris suum. The necessity of differentiating pig- from human-ascarids, when considering human infection with Ascaris suum, is discussed.

[A human case of pulmonary dirofilariasis suspected to be lung cancer]

A 50-year-old man in Kitakyushu City visited a hospital for evaluation of an opacity in a routine chest X-ray film. After examinations by bronchoscopy and chest roentgenography, a clear coin lesion was found in the middle lobe of the right lung and was suspected to be a lung cancer. A right thoracotomy was performed to remove it. The lesion (10.6 X 9.8 mm) was a well-defined ellipsoid granuloma due to a foreign body with a central zone of necrosis surrounded entirely by a fibrous wall. In a cross section of the dissected granuloma two degenerated worm-like structures were revealed. The sections of the worm (216-240 X 296 mu m at the greatest diameter) had at least a 3-layered cuticle and prominent internal longitudinal cuticular ridges but no external cuticular ridges. The lateral chords were as high as the muscle layer which consisted of abundant somatic muscle (more than 30 muscle cells/quadrant). Judging from these morphological characteristics, the pulmonary granulomatosis was diagnosed to be due to an immature dog heartworm, Dirofilaria immitis. This identification was further supported by results from immunological methods. The present case is the 56th human case of dirofilariasis (the 39th as a pulmonary case only) in Japan.

[Fifty-six cases of human dirofilariasis reported in Japan--a complied table]

Since the first reported case of human dirofilariasis in 1964, a total of 56 cases have been recorded from Japan, including 39 pulmonary and 16 extra-pulmonary cases. The difference in case number between pulmonary and extre-pulmonary sites is statistically highly significant (P = 0.001). Distribution of the lesion in pulmonary dirofilariasis is mainly concentrated in the right lung (P less than 0.001). The rapid increase of human dirofilariasis within the last 5 years indicates that this disease is one of the important anthropozoonoses.

[The correlation between the productive capacity of carcinoembryonic antigen (CEA) and prognosis in gastric cancer]

In 130 resected specimens of gastric cancer, CEA was stained by the enzyme labeled antibody method. The positive rate of CEA stain was 74.6% and higher in well differentiated adenocarcinoma, mucinous adenocarcinoma, and signet ring cell carcinoma. The positive rate was lower in poorly differentiated adenocarcinoma. The 5-year survival rate was higher in the CEA (-) group in stage II, and higher in the CEA (+) group in stage III (p less than 0.05) and stage IV. This suggests that the correlation of the CEA stain and the prognosis varies with the stage of cancer.

[Gliomatosis peritonei]

Gliomatosis peritonei, the miliary implants of mature glial tissues on the peritoneum or omentum, is a rare complication of solid ovarian teratoma. Our case is reported and 38 previously reported cases are reviewed. The grade of the primary tumors varied from grade 0 to grade 3. Only five cases were composed entirely of mature tissues. Five of the 39 patients died. Despite of varied therapy, the rest of the patients were alive from 3 months to 38 years later. Inspite of intraperitoneal implants, the prognosis in patients with these tumors is good, irrespective of the mode of therapy. On the basis of this study, we recommended a conservative therapy for the primary tumor and therapy for the implants is not required.

[Surgical problems of Kock's continent ileostomy in patients with ulcerative colitis]

Postoperative problems including pathophysiology at follow up were investigated in Kock's continent ileostomy in patients with ulcerative colitis. The results obtained were as follows: Though postoperative complication was found in all 4 cases, it was improved in 3 of them by conservative or surgical treatment. Troublesome skin irritation, such as erosion or ulcer, was not found in any case. The patients empty the reservoir when it is convenient and intestinal discharge was 1 to 4 times per day and these results were proved from the studies of the pressure and capacity in the Kock's ileostomy. Various plasma amino acids in patients with Kock's ileostomy showed almost similar levels to those of the normal subjects. Bacteriological examination in the stool in Kock's ileostomy also revealed almost similar results to those of the normal subjects. From these results, we conclude that Kock's continent ileostomy should be more widely performed for the patients with ulcerative colitis when ileostomy is required.

[Reevaluation of the biological control of vector mosquitoes using predatory larvae of Toxorhynchites mosquitoes]

Attempts to control mosquito-borne disease using predatory mosquitoes such as Toxorhynchites larvae have led to indefinite results for many years, mainly because of the lack of adequate species or strains of Toxorhynchites. Recent improvements of natural and artificial matings of adults in the laboratory and of mass breeding of larvae, however, have made it possible to establish laboratory colonies of most Toxorhynchites species whenever and wherever necessary. Effects of biological control by releasing large numbers of Toxorhynchites mosquitoes should be reevaluated from a new concept of comparing the usual chemical insecticides with the living and flying "insecticides" which cause no environmental pollution.

[The concentration of cefmenoxime after intravenous drip infusion in digestive organs and exudates from abdominal and thoracic cavities in human]

We investigated the concentrations of cefmenoxime (CMX) after administration of 2 g of CMX, in the tissues resected during operation 2 hours after the beginning of intravenous drip infusion, and in the exudates from abdominal or thoracic cavities in the postoperative period. The results were as follows: The highest tissue concentration of CMX was found in the liver (59.0 +/- 20.3 micrograms/g), and the lowest was in the pancreas (13.9 +/- 8.1 micrograms/g). The concentrations of CMX in the tissues were in order of liver much greater than colon = esophagus = stomach greater than pancreas. The peak concentration of CMX in exudate from thoracic cavity was 15.6 +/- 10.1 micrograms/ml, and was observed 2 hours after the beginning of intravenous drip infusion, later than that in serum. Furthermore, the concentration of the exudate was maintained to a reasonable extent for 5 hours. The concentrations of CMX in both tissues and exudates were enough to inhibit the growth of many kinds of bacteria isolated from abdominal infections.

Two stage total gastrectomy in a case of multiple bleeding gastric ulcers

A 78-year-old man with severe diabetes mellitus fell into shock due to bleeding from multiple gastric ulcers. Near-total gastrectomy without reconstruction was performed in the initial operation to save his life. After his general condition improved, total gastrectomy with Roux-en-Y esophagojejunostomy was performed in a second procedure. As this two stage total gastrectomy can avoid excessive operative stress, and prevent rebleeding and breakdown at the anastomosis, we consider it a valuable procedure for patients who have multiple bleeding gastric ulcers involving almost the whole stomach, and who have very poor general condition or severe complications at the time of operation.

[The mechanism of action of E.coli endotoxin on oxidative phosphorylation of the rat liver mitochondria]

The effects of E.coli endotoxin on oxidative phosphorylation were investigated in vitro using isolated rat liver mitochondria. The respiratory control index (RCI) was significantly decreased by preincubation of mitochondria for 20 min. at 30 degrees C in the presence of the endotoxin, which repressed dose-dependently the state 3 respiration. The extent of the repression of this state 3 respiration was comparable with that of the exchange reaction of adenine nucleotide. The endotoxin, however, did not inhibit several mitochondrial enzymes including the electron transport system at the enzyme level. The exchange reaction and the number of the ADP-binding sites of the adenine nucleotide carrier were assayed using [14C] ADP and [3H] carboxyatractyloside, respectively. The exchange reaction was repressed by 72% and the number of binding site of carboxyatractyloside was decreased by 20% by the endotoxin (100 micrograms/mg mitochondrial protein). These effects of endotoxin on the adenine nucleotide carrier were additionally enhanced by the Ca2+ ion. The occurrence of these effects was prevented by EGTA or dibucaine, a potent inhibitor of phospholipase A2. These results suggested that the endotoxin may activate phospholipase A2 which may harm the lipid layer of the mitochondrial membrane.

Technical notes on acrylamide gel electrophoresis used for comparing isozymes of mosquito larvae

Various slight modifications of electrophoretic techniques were tried to obtain more reproducible results for comparing several isozymes with individual mosquito larvae. Horizontal electrophoresis was done using polyacrylamide gel plates of 1 mm thickness on a simple cooling system in which ice-cold water was circulated. This made it possible to carry out electrophoresis effectively even during field work in tropical areas. Gel concentration in routine work is 5% for usual enzymes, but for esterase, 6% gels have been adopted. Gel concentrations, running distance, running time, visualization of isozyme bands, etc., have especially been considered.

[Experimental studies of the effect of diltiazem (Ca-antagonist) on cerebral circulation and cerebral arterial spasm]

Polygraphycal studies were carried out in order to evaluate the effects of Diltiazem (Ca-antagonist) on cerebral circulation in cats. In addition to these studies, the inhibitory effect of Diltiazem on incubated blood-, and serotonin-induced vasocontraction of basilar arteries was observed through on operating microscope. Experimental vasospasm were induced by local administration of incubated blood and 10(-5)--10(-6) M serotonin solution. The required dose of Diltiazem, 30-300 micrograms/kg, was injected by one shot intravenously. CBF slightly decreased concomitantly with transiently decreased blood pressure shortly after intravenous injection of Diltiazem. After that, CBF increased for 15-20 minutes and returned to the state similar to that before the administration of Diltiazem. The changes in reactive pattern of CBF depend on the doses of Diltiazem and related to changes of CAR and VAR which were thought to indicate the blood of cardiac output. Vasocontraction induced by incubated blood and serotonin was released 30-35 per cent for 30 minutes after intravenous injection of Diltiazem 100 micrograms/kg. However, by administration of Diltiazem before and after local application of incubated blood and serotonin on basilar arteries, vasocontraction was inhibited completely. These data suggest that administration of Diltiazem (Ca-antagonist) might be useful in the prophylaxis and treatment of vasospasm following rupture of cerebral aneurysm.

[Cervical carotid endarterectomy for vertebrobasilar insufficiency]

A 66-year-old man was admitted with 2-year history of progressing gait difficulty and speech disturbance. His neurological examination on admission demonstrated dysarthria, truncal ataxia, mild foot weakness and emotional incontinence. Computerized tomography revealed enlarged ventricle with marked brain stem atrophy. Cerebral angiography showed 90% stenosis of left upper vertebral artery, 90% stenosis of mid basilar artery, occlusion of right upper vertebral artery and 50% stenosis with ulcer of right cervical carotid artery. Right cervical carotid endarterectomy was carried out with continuous electroencephalography (EEG) monitoring. Post-operative course was uneventful and the patient had gradual neurological improvement. This case was reported to be of help to judge the indication of such operation in effectiveness and also the value of EEG monitoring during operation.