Prediction of drug responses in schizophrenia: a method using a test dose of chlorpromazine

Thirty-seven newly admitted schizophrenic patients were treated with an open and flexible dosage of chlorpromazine for 3 months after receiving a test dose. Levels of chlorpromazine, demethylated chlorpromazine and chlorpromazine sulfoxide 3 h after the test dose were measured. Twenty-three patients responded to long-term chlorpromazine treatment but 14 did not, a rate of 62.2%. A discriminant function analysis was performed using variables relating to the patients, backgrounds added to the ratios of plasma drug levels separately by sex to increase predictability over the level of previous studies. The obtained equations were applied to 23 newly admitted schizophrenic patients, with the prescription of chlorpromazine for designated responders and haloperidol for designated non-responders for 4 weeks. The patients in the latter study responded better than those of the former with chlorpromazine alone; 71.4 and 88.9% of chlorpromazine- and haloperidol-treated groups improved, respectively, for an overall rate of 78.3%. However, the chlorpromazine-treated group had a lower level of positive symptoms than the haloperidol-treated group before treatment and this and other differences between the groups should be further examined.

N-acyl amino acid biosynthesis in marine bacterium, Deleya marina

We reported previously that the marine bacterium, Deleya marina (ATCC 25374), produced N-acyl leucine and isoleucine, in which nonhydroxy fatty acid was linked to alpha-amino group of amino acid. Further analysis of bacterium lipids revealed the additional production of N-acyl ornithine. The N-acyl ornithine had a 3-hydroxy fatty acid linked by an amide bond to a-amino group of ornithine and a nonhydroxy fatty acid esterified to the hydroxy group of the 3-hydroxy fatty acid. N-acyl ornithine was located in the cell membrane and N-acyl leucine and isoleucine in cytoplasm. N-acyl ornithine is thought to be a functional analogue of phosphatidylethanolamine (PE) because of their similar structure. PE replacement into N-acyl ornithine in the cell membrane under phosphate-limited conditions was observed with other bacteria, so we anticipated the nonbiosynthesis of N-acyl ornithine under phosphate-sufficient conditions. We did not anticipate that N-acyl leucine and isoleucine in cytoplasm, whose structure is dissimilar to that of PE, would be replaced into PE in the cell membrane. Neither N-acyl leucine, N-acyl isoleucine, nor N-acyl ornithine was biosynthesized under phosphate-sufficient condition. Thus, we report here for the first time that N-acyl amino acids in cytoplasm were not biosynthesized under phosphate-sufficient conditions.

Flow-dependent regulation of nitric oxide formation in the isolated canine mesenteric arterial bed

Effects of flow rate changes on nitric oxide (NO) formation in vascular endothelial cells were investigated in isolated canine mesenteric arterial bed preparations. Stepwise increases in the flow rate from 8 ml/min to 40 ml/min significantly (P <0.05) elevated perfusion pressure in a rate-dependent manner. In the presence of N(G)-nitro-L-arginine (L-NNA, 100 microM), perfusion pressures were significantly (P<0.01) higher than those observed under control conditions at all flow rates examined. Sodium nitroprusside (SNP) (0.1-10 microM) counteracted the pressor effect of L-NNA in a concentration-dependent manner. Increases in the flow rate from 10 ml/min to 40 ml/min significantly (P < 0.05) augmented cyclic GMP production in the vascular bed preparation. The flow-induced cyclic GMP response was significantly (P <0.05) attenuated by L-NNA (100 microM). These results demonstrate that 1) the amount of NO released from endothelial cells toward vascular smooth muscle cells can be semi-quantified with SNP, and 2) an increase in the flow rate stimulates NO formation in endothelial cells of resistance arteries, which may play an important part in regulating systemic blood pressure.

Purification and characterization of diacylglycerol acyltransferase from the lipid body fraction of an oleaginous fungus

Diacylglycerol acyltransferase (DGAT) [EC 2.3.1.20] was purified to apparent homogeneity from the lipid body fraction of an oleaginous fungus, Mortierella ramanniana var. angulispora. The enzyme was solubilized from the lipid body fraction with 0.1% Triton X-100, and purified by subsequent column chromatography on Yellow 86 agarose, Superdex-200, Heparin-Sepharose, second Superdex-200, and second Yellow 86 agarose. The enzyme activity was finally enriched 4,802-fold over that of the starting 1,500X g supernatant. The apparent molecular mass of the enzyme was 53 kDa on SDS polyacrylamide gel electrophoresis. The purified enzyme did not exhibit glycerol-3-phosphate acyltransferase, lysophosphatidic acid acyltransferase, lipase, transacylase, or acyl-CoA hydrolase activities, although 2-monoolein was acylated with about a half of the enzyme activity toward 1,2-diolein. The purified DGAT depended on exogenous sn-1,2-diolein and oleoyl-CoA, with the highest activity at about 200 and 20 microM, respectively. Purified DGAT utilized a broad range of molecular species of both diacylglycerol and acyl-CoA as substrates. The highest activity was observed with sn-1,2-diolein and lauroyl-CoA. Anionic phospholipids such as phosphatidic acid (PA) activated the purified enzyme, as found for the Triton X-100 extract. Sphingosine dose-dependently inhibited DGAT activity activated by PA and basal activity without PA. These results provide a basis for further studies on the molecular mechanism of triacylglycerol biosynthesis and lipid body formation, in which DGAT plays an important role.

The potent inhibition of vapiprost, a novel thromboxane A2 receptor antagonist, on the secondary aggregation and ATP release of human platelets

The inhibitory effects of vapiprost hydrochloride (vapiprost), a novel thromboxane A2 receptor antagonist, on platelet aggregation and ATP release were studied using platelet rich plasma (PRP) of humans, guinea pigs, rabbits and rats. In in vitro experiments with human platelet, vapiprost inhibited the aggregation and ATP release stimulated with U-46619, collagen or arachidonic acid (AA) at an IC50 of less than 2.1 x 10(-8) M. Vapiprost did not inhibit the primary aggregation or ATP release of human platelets stimulated with adenosine 5'-diphosphate (ADP), epinephrine (Epi) or platelet activating factor (PAF), but inhibited the secondary aggregation stimulated with those agonists at an IC50 of less than 1.3 x 10(-7) M. The sensitivity of platelets in various species of animals to vapiprost was in the following order: human > or = guinea pigs > rats > rabbits. In ex vivo experiments with guinea pigs which received a single oral dose of vapiprost, the agent demonstrated strong inhibition of ATP release from platelets stimulated with U-46619, collagen or AA at an ID50 of less than 25.8 micrograms/kg. These inhibitory effects were observed within 30 min and sustained for 24 h at a single dosage of 5 mg/kg of vapiprost. In AA-induced pulmonary infarction models of mice, the sudden death rates decreased significantly with the oral administration of 10 mg/kg or more of vapiprost. These results indicate that vapiprost effectively inhibits the secondary aggregation and ATP release of human platelets stimulated with various agonists, and that guinea pig and human platelets are similar in response to vapiprost. Furthermore, it was demonstrated in ex vivo experiments with guinea pigs that the inhibitory action of vapiprost appears rapidly and lasts for long periods.

Delayed hyperemia causing intracranial hypertension after cardiopulmonary resuscitation

OBJECTIVE

To clarify whether early or delayed failure of cerebral perfusion after cardiopulmonary resuscitation (CPR) occurs in humans and contributes to secondary brain damage.

DESIGN

Prospective, repeated-measures study.

SETTING

Intensive care unit of Hiroshima University School of Medicine.

PATIENTS

Eight comatose patients who had undergone successful resuscitation from cardiac arrest.

INTERVENTIONS

All patients underwent transcranial Doppler sonography examination. The intracranial cerebral pressure (ICP) and jugular venous oxygen saturation (SO2) also were continuously monitored in five patients and three patients, respectively.

MEASUREMENTS AND MAIN RESULTS

In each patient, we measured the mean flow velocity of the middle cerebral artery transcranially and the mean flow velocity of the internal carotid artery, high in the neck, using transcranial Doppler sonography. The pulsatility index for each measurement was also calculated. The first examinations were performed within 4 to 12 hrs of CPR, and repeat examinations were performed approximately every 12 hrs. The initial mean flow velocities of the middle cerebral artery and the initial mean flow velocities of the internal carotid artery were relatively low, with relatively high pulsatility indices. The mean flow velocities of the middle cerebral artery began to increase at 12 to 24 hrs after CPR and peaked 24 to 120 hrs after CPR. A simultaneous increase in mean flow velocities of the internal carotid artery was observed during this period. The pulsatility index in both arteries dropped significantly during peak mean flow velocity of the middle cerebral artery. In six of seven patients with an abnormal increase (> 100 cm/ sec) in peak mean flow velocity of the middle cerebral artery, the ratio of mean flow velocity of the middle cerebral artery to mean flow velocity of the internal carotid artery was < 3. This value tended to be lower in patients with poor outcomes. An increased mean flow velocity of the middle cerebral artery, with a ratio of < 3 for mean flow velocity of the middle cerebral artery to mean flow velocity of the internal carotid artery, was defined as hyperemia. Although the mean flow velocity of the internal carotid artery was not measured, another patient with an abnormal increase in mean flow velocity of the middle cerebral artery revealed a high jugular venous SO2 value of 83.5%, also representing hyperemia. All ICP values were within the normal range 4 to 12 hrs after CPR and tended to increase before peak mean flow velocity of the middle cerebral artery. The two patients with the lowest ratios of mean flow velocity of the middle cerebral artery to mean flow velocity of the internal carotid artery showed significant increases in ICP after the peak mean flow velocity of the middle cerebral artery. These two patients subsequently developed brain death.

CONCLUSIONS

Delayed hyperemia occurs in humans after resuscitation from cardiac arrest. Our data suggest that this delayed hyperemia can lead to intracranial hypertension and occasionally acute brain swelling, contributing to a poor outcome. A high mean flow velocity of the middle cerebral artery with a low ratio of mean flow velocity of the middle cerebral artery to mean flow velocity of the internal carotid artery may be predictive of critical hyperemia. As an indirect method of measuring cerebral blood flow transcranial Doppler sonography can be used to adjust treatment for failure of cerebral perfusion after resuscitation.

Dietary effect of a symmetrical triacylglycerol, 1,3-biseicosapentaenoyl-2-gamma-linolenoyl glycerol, on fatty acid composition of guinea pigs

The dietary effect of 1,3-biseicosapentaenoyl-2-gamma-linolenoyl glycerol (STG) on the fatty acid composition of guinea pigs was examined and compared with that of an eicosapentaenoic acid ethyl ester (EPA-E) and of a soybean oil (SBO) diet. In terms of content of plasma lipid, EPA-E had a greater hypolipidemic effect than STG. On the other hand, in terms of EPA incorporation, contents of EPA in liver lipid were almost the same in the STG and EPA-E groups. Considering that the amount of EPA administered in the EPA-E group was almost 1.5 times that of the STG group, EPA may be absorbed more effectively as the glycerol ester than as the ethyl ester in guinea pigs. In all the tissue lipids, the STG group had a higher unsaturation index (UI) than the EPA-E group even though there is a lower UI in the STG diet than the EPA-E diet. These results suggest that greater amounts of desaturase products as a whole were synthesized in the STG group than in the other two groups. The dihomo-gamma-linolenic acid/arachidonic acid (DGLA/AA) ratio in plasma total lipids in the STG group was 3.5 times that of SBO group, and the DGLA/AA ratio in the EPA-E group was half that of the SBO group. In liver lipid, the ratios of DGLA/AA and EPA/AA in the STG group were 0.687 and 0.488 (phosphatidylcholine fraction) and 0.237 and 0.752 (phosphatidylethanolamine fraction), respectively. The ratio of DGLA/AA as well as the high EPA/AA ratio obtained in the present study with the STG diet may lead to physiological alterations, including enhanced synthesis of 1- and 3-series eicosanoids.

Flow regulates vasodilator responses to acetylcholine in the isolated canine mesenteric arterial bed

Raising the flow rate of the perfusate from 10 to 20 ml/min significantly suppressed vasodilator responses to acetylcholine, but not to sodium nitroprusside, in the isolated canine mesenteric arterial bed. Both acetylcholine and sodium nitroprusside augmented guanosine 3',5'-cyclic monophosphate (cyclic GMP) levels in the effluent from the vascular bed preparation, though cyclic GMP responses to these agents were not affected by raising the flow rate. These data suggest that the suppression, via raising the flow rate, of vasodilator responses to acetylcholine is not due to impaired function of the nitric oxide (NO)-cyclic GMP pathway in the mesenteric arterial bed.

[Costs of health services for the elderly and related factors in cities of Japan]

OBJECTIVES

To estimate the costs of health services for the elderly in 1994 and to examine factors affecting them.

METHODS

Questionnaires were sent to 631 cities and responses from 339 cities were received. Data obtained from questionnaires were total cost, proportion of labor sent to total cost, cost per user, cost per person eligible to receive Health services for the elderly. These variables were measured for health counseling service, health education, health examinations, functional training, and home-visit guidance.

RESULTS

The proportion of labor cost was smaller for health examinations than for other services. Health examinations and home-visit guidance showed higher correlation coefficients between the number of users and the total cost than other services. In most services, cost per eligible person were negatively correlated with the number of residents in the city and positively correlated with the number of public health nurses per resident. However, costs per user did not show a correlation. The cities which established municipal health centers had lower costs per user of health education and functional training than the cities which did not. Standardized mortality ratios of cerebrovascular disease and stomach cancer were not correlated with total cost, proportion of labor cost, cost per user, cost per eligible person in most services.

CONCLUSIONS

For the economic evaluation of health services for the elderly, it is necessary to examine the relationship between cost, both quantity and quality, and effectiveness of health services.

[Effect of nitrous oxide at sub-MAC concentrations on sevoflurane MAC in adults]

The interaction of sevoflurane and nitrous oxide (N2O) on the MAC was studied in the four groups of patients between 30-60 years of age scheduled for laparotomies. Patients received one of four different concentrations of N2O [0% (n = 14), 25% (n = 16), 50% (n = 15), or 70% (n = 18)]. Anesthesia was induced with sevoflurane and N2O using a semiclosed circuit with a carbon dioxide absorber. After endotracheal intubation, sevoflurane and N2O end-tidal concentrations were adjusted to predetermined concentrations until the skin incision was made. The MAC values for sevoflurane in O2 and the presence of 25%, 50%, and 70% N2O were 1.68%, 1.33%, 0.82% and 0.55%, respectively. A regression analysis through all four data points yielded a linear relationship (r = -0.997). The requirement of sevoflurane decreased by approximately 1% for each 1% of N2O administered at three N2O concentrations. The extrapolated MAC value for N2O was 102%. The MAC values of sevoflurane in O2 and N2O were similar to the previously reported values. We conclude that in adults, N2O concentrations in the dose range 0-70% reduce sevoflurane MAC in a linearly additive manner.

[A case of cerebral arteriovenous malformation with accidental migration of a microcatheter during endovascular procedure]

This is a report of a case of cerebral arteriovenous malformation with accidental breakaway of a microcatheter during endovascular embolization. A 25-year-old female suddenly suffered severe headache. CT scan demonstrated intraventricular hemorrhage, and the angiogram revealed right parieto-occipital AVM. We performed endovascular embolization using a flow-directed microcatheter (1.5F BALT MAGIC catheter) 2 weeks after onset, and the microcatheter broke accidentally and a fragment of the soft tip migrated to the distal posterior cerebral artery during the procedure. Although we tried to retrieve the catheter using several retrieval devices, we failed. Two days after the procedure we undertook surgical treatment. The migrated catheter was recognized in a small feeding artery which was stretched tightly, so retrieval was very risky. Using hemoclips for trapping the part of the catheter which remained in the feeder, we were able to retrieve it by cutting the feeder. Flow-directed microcatheters are very usefull in endovascular procedures, but it is necessary to handle them carefully in accord with sufficient knowledge of their use and handling methods.

Microbial extracellular glycolipid induction of differentiation and inhibition of the protein kinase C activity of human promyelocytic leukemia cell line HL60

The biological activities of 7 microbial extracellular glycolipids including mannosylerythritol lipid (MEL)-A, MEL-B, polyol lipid (PL), rhamnolipid (RL), sophorose lipid (SL), succinoyl trehalose lipid (STL)-1, and STL-3 were investigated. All glycolipids except for RL were found to induce cell differentiation instead of cell proliferation in the human promyelocytic leukemia cell line HL60. To identify the differentiation direction of the induced cells, the leukocyte esterase activities were cytologically investigated, and the results showed that MEL-A, MEL-B, and PL induced HL60 to differentiate into granulocytes, while SL, STL-1, and STL-3 induced differentiation into monocytes. The 6 effective glycolipids also increased nitroblue tetrazolium (NBT) reducing ability, which is a common differentiation-associated characteristic in monocytes and granulocytes. Furthermore, it was also observed that these 6 glycolipids inhibited the activity of phospholipid- and Ca(2+)-dependent protein kinase. Additionally, the 6 effective glycolipids also induced the human myelogenous leukemia cell line K562 and the human basophilic leukemia cell line KU812 to differentiate into monocytes, granulocytes, and megakaryocytes.

Differentiation of human promyelocytic leukemia cell line HL60 by microbial extracellular glycolipids

Microbial extracellular glycolipids, succinoyl trehalose lipid (STL), and mannosylerythritol lipid (MEL) inhibited the growth of a human promyelocytic leukemia cell line, HL60, and induced their morphological changes. The results of specific and nonspecific leukocyte esterase activities showed that STL induced monocytotic differentiation while MEL induced granulocytic differentiation. STL and MEL markedly increased common differentiation-associated characteristics in monocytes and granulocytes, such as nitroblue tetrazolium (NBT) reducing ability, expression of Fc receptors, and phagocytic activities in HL60 cells, respectively. Neither sugar moieties nor fatty acids in the free form, the individual components of STL and MEL, were effective at inducing the differentiation of HL60 cells. The induction of differentiation was not due to surface activities of STL and MEL on the basis of the complete ineffectiveness of the analogues tested. The composition of cell surface glycosphingolipids (GSL) changed such that the GM3/LacCer ratio increased in STL-treated cells, whereas it decreased in MEL-treated cells. HL60 cells treated with STL and MEL exhibited a significant decrease in the activity of the intracellular phospholipid- and Ca(2+)-dependent protein kinase (protein kinase C). Furthermore, the serine/threonine phosphorylations in intact HL60 cells were clearly inhibited by the presence of GM3 and MEL, but not by LacCer and STL. These results suggest that the differentiation-inducing activity of STL and MEL is not due to a simple detergent-like effect but due to a specific action on the plasma membrane. The inhibitory effect of STL on protein kinase activity was through increasing GM3, but MEL had a direct inhibitory effect.

Age-related changes in the DNA and RNA content of the brain in spontaneously hypertensive rats

To elucidate the effects of aging accompanied with hypertension on brain nucleic acid, we measured both the DNA and RNA contents of six specific brain regions in adult (5-6 months old) and aged (18-22 months old) female spontaneously hypertensive rats (SHRs). Although no statistical difference was observed in the RNA content, the DNA content did tend to increase in the hippocampal CA1 of aged SHR (4.24 +/- 0.55 ng/microgram protein, mean +/- SD, n = 6) in comparison to that of adult SHR (3.21 +/- 0.71 ng/microgram protein, n = 4). Hence, aged SHRs showed a significant decrease in the RNA to DNA ratio in the CA1 subfield of the hippocampus (3.79 +/- 0.61) compared to adult SHR (5.27 +/- 0.81). On the other hand, no other regions, except for the dorsolateral region of the striatum, showed any difference in the RNA/DNA ratio between aged and adult SHR. We therefore conclude that subtle changes in the nucleic acid occur in vulnerable regions of the brain in aged SHRs.

Fluid-attenuated inversion recovery (FLAIR) in a patient with parasagittal white matter shearing injury

We present a 32-year-old woman with a parasagittal white matter shearing injury of the left frontal lobe following a motor vehicle collision. There was monoplegia of the right lower extremity. Computed tomography failed to demonstrate the lesion which was visible on magnetic resonance images. In particular, fluid-attenuated inversion recovery images were useful to depict the shearing injury, since sulci were of low intensity on those images.

Endoscopic resection of intraventricular ependymal cyst presenting with psychosis

BACKGROUND

Intracranial ependymal cysts are rare lesions generally located in the cerebral parenchyma, juxtraventricular region, or subarachnoid space; but no case of a purely intraventricular ependymal cyst has been reported.

CASE REPORT

A case of intraventricular ependymal cyst presenting with symptoms of psychosis is reported. The patient's symptoms resolved almost completely following endoscopic resection of the cyst. The embryologic basis of the development of an ependymal cyst inside the ventricle and its histologic characteristics are discussed. Possible mechanism of psychosis in this case is also discussed.

CONCLUSION

Minimally invasive techniques, as in this case, may be useful in refractory psychotic cases with cystic lesions.

Oleate 6-hydroxylase activity in the membrane fraction from an oleaginous fungus, Mortierella ramanniana var. angulispora

Conversion of [1-14C]oleoyl-CoA (OA-CoA) in subcellular fractions of an oleaginous fungus, Mortierella ramanniana var. angulispora (IFO 8187) was investigated. The membrane fraction actively catalyzed the transformation of OA-CoA into one metabolite, which was identified as 6-hydroxy oleic acid (6-HOOA) by GC-MS analysis. The enzyme activity to form 6-HOOA was dependent on OA-CoA concentrations and increased linearly with incubation time and protein concentrations under appropriate experimental conditions. Since the enzyme activity required molecular oxygen and reduced pyridine nucleotides (NADH and NADPH), it was most probable that the formation of 6-HOOA was ascribed to direct hydroxylation to the C6 position, oleate 6-hydroxylase. 6-HOOA was formed from free oleic acid (OA) and OA-NH4 salt as substrate as well as OA-CoA, but not from OA covalently bound to phosphatidylcholine or triacylglycerol. Since CoA stimulated the hydroxylation of free OA and OA-NH4 salt but not that of OA-CoA, OA may be converted to OA-CoA and then hydroxylated. The enzyme activity was distinctly reduced by addition of lysophosphatidic acid, phosphatidic acid and dithiothreitol. Since hydroxy fatty acids are very minor components in this fungus, it may raise the possibility that the 6-hydroxylase activity works for other functions such as comprising one step for desaturation as well as forming the hydroxy fatty acids.

[A case of subdural empyema with hemorrhage]

A rare case of subdural empyema accompanied by hemorrhage in a 2-year-old boy is reported. The patient was hospitalized on May 31, 1995 because of high fever. Lumbar puncture was performed, a diagnosis of suppurative meningitis was made, and streptococcus pneumoniae was cultured from the CSF. The next day, the patient experienced convulsions, and CT scans revealed left subdural empyema. Intensive antibiotic therapy was performed for 16 days from the onset of symptoms, but the patient's fever persisted, and the area of subdural empyema had grown larger on CT scan on June 15th. He was transferred to our institution the same day. Enhanced MRI clearly showed the capsule of the empyema in the left subdural space. Evacuation of the empyema and irrigation of the cavity were performed via a single burr hole. The old bloody fluid was found to be accompanied by a yellowish-white abscess in the subdural space. We concluded that the source of the bleeding was probably the fragile vessels in the capsule. The patient recovered after surgical treatment and a prolonged course of antibiotic therapy.

Health and welfare administration system in Japan

The health and welfare administration system in Japan is based on the concept of "welfare nation" in the Constitution, and the Ministry of Health and Welfare has prime responsibility for general health and welfare administration. There are two levels of the prefectural governments and municipal governments with their own assemblies. The health centers and the welfare offices are special and first-line organizations for the health and welfare administration, and they are operated by the prefectures or large municipalities in principle. This system has now been experiencing the reform adapted to the aging of population, based on the amendment to the Health Service for the Aged Law and so on in 1990 and the amendment to the Health Center Law in 1994, which is now the Community Health Law. The municipal government is becoming a first-line organization for the health and welfare administration and its responsibility is growing especially in the personal service for the residents.

Infusions of pressor agents selectively attenuate depressor responses to ACh in anesthetized dogs

In dogs anesthetized with pentobarbital sodium (30 mg/kg iv), infusions of phenylephrine (PE; 1-3 micrograms.kg-1.min-1 iv for 30 min and longer) caused sustained elevations in blood pressure and suppressed depressor responses to acetylcholine (ACh; 1 microgram/kg iv) in a dose- and time-dependent manner. The dose-response curve for ACh (0.01-100 micrograms/kg iv)-induced depressor responses was shifted to the right by approximately 80-fold after an intravenous infusion of PE (3 micrograms.kg-1.min-1) for 120 min. Similar suppression was observed when infusions of methoxamine (5 micrograms.kg-1.min-1 iv), norepinephrine (3 micrograms.kg-1.min-1 iv under blockade of beta-adrenoceptors), or angiotensin II (0.3 micrograms.kg-1.min-1 iv) were carried out. However, in dogs treated with prazosin (1 mg/kg iv) or hydralazine (1 mg/kg iv) to prevent elevations in blood pressure over the baseline level, PE (3 micrograms.kg-1.min-1 iv) failed to attenuate depressor responses to ACh. The suppression observed after PE infusion was specific to ACh-induced depressor responses; i.e., no suppression was observed on the depressor responses to other drugs, such as histamine, sodium nitroprusside, carbachol, and methacholine. Furthermore, neostigmine (bolus injection of 30 microgram/kg iv followed by an infusion of 15 micrograms.kg-1.h-1 iv) greatly diminished the suppressive effect of PE. Except for a slight increase in acetylcholinesterase (AChE) activity in renal arterial segments, activities of both AChE and butyryl-cholinesterase in plasma, erythrocytes, and pulmonary and renal arterial segments were unchanged after PE infusion. These results suggest that prolonged elevation in blood pressure and/or vasoconstriction selectively attenuates depressor responses to ACh through accelerated degradation of this material.

Epigenetic modifications during oocyte growth correlates with extended parthenogenetic development in the mouse

In mammals, the maternal and paternal genomes are required for embryonic development. This is due to genomic imprinting which leads to the expression or repression of genes solely on the basis of the parent from which they were inherited. As a result, parthenogenetic embryos die before day 10 of gestation and show limited development of extra-embryonic membranes. Maternal imprinting is established during oogenesis and is associated with allele specific modifications in DNA methylation. We have investigated epigenetic modifications during oocyte growth using nuclear transfer techniques to produce mature oocytes with maternal chromatin derived from non-growing oocytes. Parthenogenetic activation of such oocytes leads to the development of normal size fetuses with a well developed placenta on day 13.5 of gestation; three days further than previously recorded for parthenogenetic development. In contrast, after fertilization, only one embryo was recovered on 9.5 days of gestation. Further, in these embryos we investigated the well characterized methylation pattern of the maternally expressed insulin-like growth factor II receptor gene (Igf2r) and found that the pattern of methylation was indeed different to that of fertilized control embryos. Thus, the embryonic phenotypes observed here correlate with changes in epigenetic events that normally occur during oocyte growth.

Intrasellar meningioma: characteristic imaging findings

Intrasellar meningioma is rare. We present a case in which both angiography and dynamic contrast-enhanced MRI suggests the diagnosis.

Effect of the eradication of Helicobacter pylori on duodenal ulcer healing and ulcer relapse: randomized controlled study in Japan

To investigate the effect of the eradication of Helicobacter pylori on the healing and relapse of duodenal ulcers. 50 patients with active duodenal ulcer and H. pylori infection were randomly allocated to two treatment groups. One group (cimetidine group) received cimetidine 400 mg twice daily for 6 weeks and the other group (double-therapy group) received 300 mg amoxicillin granules and 250 mg metronidazole thrice daily for 2 weeks, in addition to the same regimen of cimetidine as the cimetidine group. Forty-two patients completed the study. After confirmation of ulcer scar, all patients were followed up for 6 months while receiving treatment with teprenone, an agent that does not affect acid secretion or the eradication of H. pylori. The healing rates at 6 weeks were 90% in the cimetidine group and 95.5% in the double-therapy group. H. pylori eradication occurred in 0% of the cimetidine group and in 73.7% of the double-therapy group (P = 0.004). The cumulative relapse rates in the two groups at 6 months were 64.3% and 11.1%, respectively (P = 0.0007). In the double-therapy group, the cumulative relapse rate at 6 months in the patients in whom H. pylori persisted was 50% (2/4); the rate was 0% (0/14) in the patients in whom H. pylori had been eradicated (P = 0.005). Histological gastritis significantly improved compared with the baseline in the double-therapy group, but no such improvement was seen in the cimetidine group. White scarring was found in 7.1% of the cimetidine group and in 83.3% of the double-therapy group after 6 months (P < 0.0001). The eradication of H. pylori markedly decreased the relapse rate in duodenal ulcer patients, and it significantly improved both the grade of gastritis and the quality of the ulcer scar.

[Public health nurse staffing requirements for health examination of infants and children in municipalities of Japan]

In accordance with the Maternal and Child Health Service Act, public health centers and municipalities offer health education, health counseling, health examinations, and home visits for children and their mothers in their jurisdiction. On the basis of the new Maternal and Child Health Service Act, municipalities will have the responsibility to effectively promote health examination for three-year-old children beginning in 1997. To provide health examinations to infants and children, establishing a health personnel system, especially the public health nurse program, is extremely important. The purpose of this study is to determine fundamental facts concerning health manpower development among public health nurses in the municipalities, by reviewing research on health examinations for both infants and children. To determine personnel staffing requirements necessary for health examinations of infants and children in the municipalities of Japan, pertinent references were systematically reviewed. The main results are as follows; 1) The correlation coefficients between the total working hours of the public health nurse for MCH and the population per area and number of birth per year were significantly positive. 2) Total working hours for health examination of three-year-old children per 100 births per year, by the public health nurse were 143 hours, of which 79% were spent just for performing the examination itself. 3) Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with a population of less than 3,000, 43% of the total volume of work performed by public health nurses during the health examinations of three-year-old children required the assistance of prefectural public health nurses. 4) On the other hand, in those areas with populations more than 10,000, 88% of the total volume of work required to be performed by public health nurses during the health examinations for three-year-old children was covered by municipal public health nurses. 5) When the total number of working hours of the public health nurse for Maternal and Child Health was divided into the four parts of planning, implementation, evaluation and training, 86.7% of working hours were spent on implementation itself. 6) In those cities designated by the Government, the health personnel system was sufficient to carry out these health examinations. 7) It was found that in towns and villages with small populations, the health examinations for infants and children can be better carried out in combination with assistance by prefectural public health nurses. 8) The review of the findings suggests that it is important to clarify by further studies not only the relationship between the health manpower system and implementation of the health examination but also the relationship between this system and the effectiveness of the health examination in near future.

Activation of detergent-solubilized diacylglycerol acyltransferase by anionic phospholipids

Diacylglycerol acyltransferase (DGAT), which catalyzes the final step in triacylglycerol (TG) biosynthesis, is crucial for lipid accumulation and formation of lipid bodies in an oleaginous fungus, Mortierella ramanniana var. angulispora. Since solubilization of DGAT in the lipid body fraction from this fungus with 0.5% Triton X-100 gave very low recovery of the activity, some activation factors for solubilized DGAT activity were investigated. Addition of phospholipids, especially anionic phospholipids such as phosphatidic acid and phosphatidylserine, to the assay mixture greatly increased DGAT activity. The activation by these phospholipids was most prominent when 0.2% Triton X-100 was added to the assay mixture. The effect of phosphatidic acid was reproduced using DGAT fraction obtained by 0.5 M KCl elution on Mono S column chromatography. The results provide new insight on activation of DGAT during TG accumulation as well as optimal DGAT assay conditions for solubilized fractions.

Performance comparison between multiple-quantum-well modulator-based and vertical-cavity-surface-emitting laser-based smart pixels

We compared multiple-quantum-well modulator-based smart pixels and vertical-cavity-surface-emitting laser (VCSEL) based smart pixels in terms of optical switching power, switching speed, and electric-power consumption. Optoelectronic circuits integrating GaAs field-effect transistors are designed for smart pixels of both types under the condition that each pixel has an optical threshold and gain. It is shown that both types perform maximum throughput of ~3 Tbps/cm(2). In regard to design flexibility, the modulator type is advantageous because switching time can be reduced by supplying large electric power, whereas switching time and electric-power consumption are limited to larger than certain values in the VCSEL type. In contrast, in regard to optical implementation, the VCSEL type is advantageous because it does not need an external bias-light source, whereas the modulator type needs bias-light arrays that must be precisely located because the small modulator diameter, <10 µm, is essential to high-speed operation. A bias-light source that increases the total power consumption of the system may offset the advantages of the modulator type.

Purification and characterization of an intracellular alpha-D-xylosidase from Penicillium wortmannii IFO 7237

Intracellular alpha-D-xylosidase from Penicillium wortmannii IFO 7237 was obtained by grinding the mold with almina in phosphate buffer, and the cell-free extract was purified to a homogeneous state on SDS-polyacrylamide gel electrophoresis (SDS-PAGE). The molecular weight was estimated to be 290,000 by gel filtration chromatography (Superdex 200) and 73,000 was obtained by SDS-PAGE. The purified alpha-D-xylosidase had an isoelectric point at pH 5.0. The optimum activity for the enzyme was found to be at pH 6.5 and 45 degrees C. The enzyme showed a hydrolytic activity on p-NO2-phenyl-alpha-D-xylopyranoside (alpha-p-NPX) while methyl-alpha-D-xylopyranoside (alpha-MX) was not hydrolyzed at all. It also showed lower activity for xyloglucan oligosaccharides. The apparent Km values of the enzyme for alpha-p-NPX and isoprimeverose were 1.9 mM and 50 mM, respectively.

Succinoyl trehalose lipid induced differentiation of human monocytoid leukemic cell line U937 into monocyte-macrophages

A novel type of succinoyl trehalose lipid (STL-1) prepared from n-hexadecane-culture of Rhodococcus erythropolis SD-74 markedly inhibited the growth of a human monocytoid leukemic cell line, U937, and induced its morphological alteration along a monocyte-macrophage lineage. STL-1 markedly increased differention-associated characteristics in macrophage, such as nitroblue tetrazolium reducing ability, appearance of Fc receptor, phagocytic activities in U937. Furthermore, U937 cells, which were activated with STL-1 exhibited cytotoxic activity against human lung carcinoma cell line A549. However, STL-1 did not affect growth of a normal human fetal lung cell line TIG-1. The individual components of STL-1, neither sugar moiety nor fatty acids in the free form, were effective at inducing the differentiation of U937 cell. From these results, we concluded that STL-1 has low cytotoxicity against normal human cells and the ester molecule itself is responsible for the activity of inducing differentiation of human monocytoid leukemic cell line U937 into monocyte-macrophage which results in the stimulation of the production of some cytotoxic substances.

Technology and staffing in Japanese university hospitals. Government versus private

We examined staffing levels, acquisition of medical technologies, and utilization of those technologies in private and government teaching hospitals in Japan. Adjusting for size and case mix, we found that government hospitals acquire more technology, use that technology less, and employ a more highly skilled staff than do private hospitals.

Involvement of neurohumoral factors in the pressor mechanism of NG-nitro-L-arginine

The mechanism of the NG-nitro-L-arginine (L-NNA)-induced pressor response was examined in pentobarbital-anesthetized dogs. The pressor effect of L-NNA (50 mg/kg, i.v.) was significantly and equally diminished by pretreatment with either hexamethonium (25 mg/kg, i.v.) or phentolamine (5 mg/kg, i.v.). The intracisternal administration of L-NNA (1 mg/kg), which did not cause changes in cardiovascular parameters when administered systemically, produced a significant pressor response and tachycardia. Furthermore, significant suppression of L-NNA-induced pressor responses was observed after treatment of dogs with captopril (5 mg/kg, i.v.) or a non-peptide angiotensin II receptor antagonist, losartan (10 mg/kg, i.v.), or bilateral occlusion of renal veins. The inhibitory effects of hexamethonium and losartan were additive. These results suggest that, in addition to vasoconstriction due to the inhibition of endothelial nitric oxide production, increased activity of the sympathetic nervous and renin-angiotensin systems contributes significantly to the development of pressor responses produced by the intravenous injection of L-NNA in anesthetized dogs.

[Incidence of nausea and vomiting after cholecystectomy performed via laparotomy or laparoscopy]

Postoperative nausea and vomiting (PONV) are commonly observed adverse effects of general anesthesia. In a retrospective study of laparoscopy group (101 patient) and laparotomy group (101 patient), we evaluated the incidence of PONV after laparoscopic cholecystectomy. Most factors which could influence the incidence of PONV were not significantly different between the groups. The overall incidence of PONV during the first 17h postoperatively was 25.7% in laparoscopy group and 18.8% for laparotomy group respectively, but the risk was 3.2 times greater in laparoscopy group (15.8%) than in laparotomy group (5.0%) (P < 0.05) during the first postoperative hour. The risk of PONV was greater in laparoscopy group in female patients (23.4% versus 9.3% in laparotomy group, P < 0.05) and in obese patients (25.0% versus 0% in laparotomy group, P < 0.01) during the first postoperative hour. We conclude that laparoscopic cholecystectomy increases the incidence of PONV in early postoperative period probably by the effect of residual stretching and irritation of the peritoneum, and the risk is increased in female and obese patients.

Steal phenomenon in a traumatic carotid-cavernous fistula

A patient with head injury presented with computed tomography findings of a diffuse severe infarction of the left cerebral hemisphere in which the cerebral hemodynamics can be evaluated by transcranial Doppler sonography. Serial angiograms revealed a carotid-cavernous fistula, with a complete steal phenomenon. The unusual complication of a traumatic carotidcavernous fistula is discussed.

[The effect of clonidine on the duration of vecuronium-induced neuromuscular blockade in humans]

The clinical duration of a bolus of vecuronium 0.1 mg.kg-1 was measured in two groups of patients between 31-55 years of age undergoing elective general surgery. Eight patients received no premedication and eight others clondine 4.0-5.5 micrograms.kg-1 orally 90 minutes before arriving at the operating room. Neuromuscular blockade was continuously quantitated by recording the acceleration response to stimulation of the ulnar nerve train-of-four. Anesthesia was induced with thiamylal 5 mg.kg-1 and maintained with 50% nitrous oxide and isoflurane (Fet 0.5%) in oxygen. Supplementary doses of fentanyl (2 micrograms.kg-1 for the control group and 1 microgram.kg-1 for the clonidine group) were given before intubation and when anesthesia was considered to be insufficient. The clinical duration of vecuronium, defined as recovery to 25% of the control first twitch in the train-of-four sequence, was significantly longer in the clonidine group (51.2 +/- 7.5 minutes compared with 40.5 +/- 5.1 minutes in the control group, P < 0.01). In the duration of blockade there were no significant differences between groups for mean SBP, DBP and HR. Patients in the clonidine group required significantly less fentanyl to maintain hemodynamic stability. We conclude that clonidine prolongs the clinical duration of vecuronium by 26.4%, most probably by a pharmacokinetic interaction.

[Health personnel staffing requirements for health examination for the age of 1 1/2 in municipalities in Japan]

Municipalities in Japan offer health education, health counseling, health examination, and home visit services for each development stage of children and for their mothers. In order to determine personnel staffing requirements for the health examination for the age of 1 1/2 as of 1989, data from a questionnaire survey in 1990 conducted by the Ministry of Health and Welfare, was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for the response rate of 97.9%. Results showed that in 1989, 98.9% of the 3,012 municipalities were able to independently perform health examinations for 1 and half year old, and in only 0.9% these examination were performed by clinical hospitals. In the large cities designated by the Government, the health personnel system adequately supported these health examination. However due to lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, such as health workers or volunteers. And particularly they required help by public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, 53% of the total volume of the work required to be performed by public health nurses during the health examination had to be covered by assistance from prefectural public health nurses. While in cities with more than 300,000 population large numbers of health personnel were assigned to examinations of children, the large number of children processed resulted in inadequate time for each child/mother pair. Further study of quality levels of the examinations need to be performed.

[The structural analysis of inpatient medical cost of the aged in 81 secondary medical areas of 12 Prefectures in Japan]

In order to understand the structure of the per capita medical care expenditure of inpatients aged 70 years and over, correlational and principal component analyses were performed using several medical cost indices for fiscal 1991 in 81 secondary medical areas of 12 prefectures. Requests were sent to all of 777 municipalities in the 12 prefectures, and there were 763 responses for the response rate of 98.2%. A total of 1,647,187 residents who had been inpatients based on receipts for inpatient medical care expenditure were surveyed. There were 389,456 who responded that they had been inpatients at least once in the preceding 12 months, in 1991. The main results were as follows: 1) Of the residents aged 70 and over, 32.0% of men and 29.7% of women surveyed had at least one episode of hospital admission in the preceding 12 months in 1991. 2) Large differences in the medical care expenditure per inpatient per year for those aged 70 years and over exist in the secondary medical areas in 12 prefectures. 3) In both sexes, per capita expenditures for inpatient care per year are positively correlated with the bed-days in hospitals per inpatient per year, the bed days per receipt, the medical care expenditure per receipt, and the number of receipts per inpatient per year. On the other hand, for women it is negatively correlated with per capita medical care expenditure per day, but it is not statistically significant. 4) The medical care expenditure per inpatient per day is significantly negatively correlated with bed-days in hospital per receipt, the number of receipts per inpatient per year, bed-days in hospital per inpatient per year for both sexes. On the other hand, it is significantly positively correlated with medical care expenditure per receipt for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Personnel requirements for health examination for 6 month and 9 mont-old children in municipalities in Japan]

Based on the Maternal and Child Health Law, municipalities offer health education, health counseling, health examination, and home visitation service for children and their mothers. In order to determine the personnel staffing requirements for the health examinations of 6 and 9 month-old children conducted independently by municipalities in Japan in 1989, data from the questionnaire survey executed by the Ministry of Health and Welfare in 1990 was analyzed. Questionnaires were sent to all municipalities and there were 3,198 responses for a response rate of 97.9% Results showed that in 1989, 27.5% of the 3,198 municipalities were able to perform health examinations for 6 month-old children and 24.7% for 9 month-old children. In the case of those cities which had populations over 10,000 but under 20,000, about 30% were able to perform the health examinations for 6 and 9 month-old children independently. In those cities which had health Centers, the health personnel system most adequately supported these health examinations. Due to the lack of health personnel, rural towns and villages with small populations required public health nurses to be assisted by other staff, most often public health nurses from prefectural Health Centers. For example, in those areas with populations less than 3,000, about 42-45% of the total volume of the work required to be performed by public health nurses during the health examinations for 6 and 9 month-old children had to be covered by assistance from prefectural public health nurses.

Differential significance of nitric oxide in hypotensive mechanisms of acetylcholine and histamine in dogs

The nitric oxide synthase inhibitor, NG-nitro-L-arginine, suppressed hypotensive response to acetylcholine, but not to histamine, in pentobarbital-anesthetized dogs. Infusions of acetylcholine increased plasma cyclic GMP levels, while histamine infusions did not. These results indicate that there is an apparent difference in the contributions of nitric oxide to the hypotensive mechanisms of acetylcholine and histamine.

[Prevalence of urinary incontinence among institutionalized persons aged 60 and over in Japan]

In order to estimate the prevalence of persons experiencing urinary incontinence among the institutionalized aged 60 and over in Japan, a questionnaire survey was conducted in 16 prefectures in February 1991. The questionnaires were distributed and collected by the nurses in hospitals and in other facilities. A total of 10,022 residents were asked to answer a questionnaire on their urinary incontinence condition and 9,798 responses were analysed. The main results were as follows; 1) The prevalence rate of urinary incontinence occurring almost daily in hospitalized persons aged 60 and over was 23.3% for men, 23.8% for women. 2) The prevalence rate of urinary incontinence occurring almost daily in institutionalized persons aged 60 and over in special nursing homes was 64.2% of the aged 60 and over for men, 67.9% for women. 3) The prevalence of urinary incontinence increased with age for both sexes especially in hospitalized persons. 4) The 95% confidence interval estimate for the number of the hospitalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 31,000 to 113,000 in men and from 60,000 to 182,000 in women. 5) The 95% confidence interval estimate for the number of the institutionalized in special nursing home over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 34,000 to 50,000 in men and from 97,000 to 119,000 in women. 6) The 95% confidence interval estimate for the number of the institutionalized over 60 years old suffering from almost daily urinary incontinent incidents was estimated to be from 318,800 to 570,600 in both sexes. 7) A random sampling survey is required to elucidate the actual state of prevalence in all generations. 8) Future research should emphasize the assessment of preventive and medical interventions, as incontinence is preventable and medical and surgical treatment options are available.

Antithrombotic activity of a symmetrical triglyceride with eicosapentaenoic acid and gamma-linolenic acid in guinea pig mesenteric microvasculature

The antithrombotic effect of a synthetic symmetrical triglyceride having eicosapentaenoic acid (EPA) at positions 1 and 3, and gamma-linolenic acid (GLA) at position 2 was investigated. Administration of the triglyceride significantly increased thrombus formation time and thrombotic occlusion time induced by light irradiation and a fluorescent dye in guinea pigs after 14 days administration compared to that of soybean oil. The antithrombotic effect of the triglyceride was similar to that of EPA ethyl ester. Administration of the triglyceride increased GLA, dihomo-gamma-linolenic acid (DGLA) and EPA contents in plasma and the liver, and the ratio of DGLA to arachidonic acid. These results might be responsible for this antithrombotic effect.

[Epidemiologic study of Alnus sieboldiana Matsumura (alder) pollinosis in Ashiya city]

Alnus sieboldiana has been planted widely on denuded sites in the Rokko mountains. Its pollination season is in the latter half of that of Japanese cedar. This epidemiologic study was carried out in Ashiya in the 1991 spring hay fever season. The subjects were 532 female residents chosen at random, who had been living there more than ten years. There was an evident relation between the airbone alder pollen count and the prevalence of alder pollinosis. In the mountain town most severely inundated with alder pollen (977/sq. cm/year), the prevalence rate of alder pollinosis alone or both alder and cedar pollinosis was 26.1%. In the flat area 5 km far from south of the mountain town, where aribome pollen count was 386/sq.cm/year, the prevalence rate of alder pollinosis was 4.3%. The heavy traffic main road pass through the flat area, thus the air pollution was significantly strong in the flat area more than in the mountain town. However, we couldn't find adjuvant effect of air pollution on the alder pollinosis, which was often reported about Japanese cedar pollinosis.

Isolation and characterization of a bacterium which utilizes polyester polyurethane as a sole carbon and nitrogen source

Various soil samples were screened for the presence of microorganisms which have the ability to degrade polyurethane compounds. Two strains with good polyurethane degrading activity were isolated. The more active strain was tentatively identified as Comamonas acidovorans. This strain could utilize polyester-type polyurethanes but not the polyether-type polyurethanes as sole carbon and nitrogen sources. Adipic acid and diethylene glycol were probably the main degradation products when polyurethane was supplied as a sole carbon and nitrogen source. When ammonium nitrate was used as nitrogen source, only diethylene glycol was detected after growth on polyurethane.

[The effects of low dose clonidine on perioperative hemodynamics and anesthetic requirements in elderly patients]

The effects of clonidine, alpha 2-adrenergic receptor agonist, on perioperative hemodynamics and anesthetic requirements were studied in randomized 20 elderly patients without hypertension (ASA I-II) scheduled for elective abdominal surgery under general anesthesia. The control group (n = 10) was premedicated with oral diazepam 0.1 mg.kg-1 90 min prior to arrival in the operating room. The clonidine group (n = 10), in addition, received clonidine approximately 2.5 micrograms.kg-1 orally at the same time. Anesthesia was induced with fentanyl 2 micrograms.kg-1 and thiamylal 4 mg.kg-1. Vecuronium 0.15 mg.kg-1 following 0.01 mg.kg-1 priming dose was used to facilitate endotracheal intubation. Anesthesia was maintained with isoflurane in 50% nitrous oxide-oxygen and supplementary fentanyl. Clonidine effectively attenuated the cardiovascular response associated with laryngoscopy and tracheal intubation. Intraoperative variability of heart rate was significantly lower in patients receiving clonidine compared with controls. No significant differences in the requirements of either isoflurane or narcotic supplementation were observed between the two groups. We conclude that a low dose clonidine is a useful adjunct in the management of elderly patients without producing side effects.

Changes of motor evoked potentials in global and focal ischemic models of cats

In order to evaluate the significance of motor evoked potentials (MEPs) in central nervous system monitoring, the authors conducted two sets of experiments using feline ischemic models. Twenty-three adult mongrel cats were divided into two groups: global (n = 9) and focal ischemic (n = 14) groups. In the case of global ischemia, which was induced by hypovolemic hypotension due to blood letting, deterioration of the D wave began when the mean arterial blood pressure (MABP) approached 45 mmHg, and regional cerebral blood flow (rCBF) dropped to 40% of control. Complete disappearance of the D wave was observed below 30 mmHg in MABP and 20% of control in rCBF. In the case of focal ischemia, which was induced by transorbital occlusion of the middle cerebral artery, the percentages of rCBF at which the D wave disappeared ranged from 9 to 20%. Changes in the amplitude of the D wave--an increase and following decrease--preceded the prolongation of its latency. In contrast with the D wave I waves were too easily affected by ischemia. Moreover, rCBF at the point of disappearance of the I wave varied greatly. In conclusion, the D wave is stable in mild ischemia and is a reliable indicator of critically profound ischemia (%rCBF < 40%). Monitoring the D wave of MEPs seems to be a useful method for avoiding the deterioration of motor function by ischemic insult.

Preoperative diagnosis of a small, depressed rectal cancer complicating ulcerative colitis. Report of a case

PURPOSE

This study was designed to clarify the importance of detecting small, depressed colorectal cancer complicating ulcerative colitis.

METHODS

A 39-year-old Japanese male, who had an 18-year history of left-sided ulcerative colitis, was admitted to Fukuoka University Hospital for further evaluation of his colitis. Colonoscopy with a dye spraying method clearly revealed a small, depressed lesion and flat plaque-like lesions in the rectum. Biopsies taken from a depressed lesion and plaque-like lesions revealed a signet-ring cell carcinoma and dysplasia, respectively. Total colectomy was performed.

RESULTS

Sections from the depressed rectal lesion, measuring 7 x 8 mm in size, revealed a signet-ring cell carcinoma that diffusely invaded the muscularis propria. Lymph node metastasis was evident. Flat plaques and mucosa around the depressed lesion were positive for dysplasia.

CONCLUSION

This is the first report of a case of small, depressed rectal cancer complicating ulcerative colitis diagnosed by preoperative colonoscopy. To improve outcome of colonoscopic surveillance in ulcerative colitis, detecting such small, depressed lesions are important, and colonoscopy with a dye spraying method would be useful in detecting them.

The effect of phencyclidine on the basal and high potassium evoked extracellular GABA levels in the striatum of freely-moving rats: an in vivo microdialysis study

The effect of phencyclidine (PCP) on the gamma-aminobutyric acid-ergic (GABAergic) transmission in the striatum of freely-moving rats was investigated using an in vivo microdialysis. The high potassium (100 mM) increased the extracellular GABA level to 4000% of the basal level. Although the basal GABA level in the striatal dialysate did not show either calcium dependency or tetrodotoxin (TTX) sensitivity, the high potassium evoked GABA level was reduced by 82% under calcium-free conditions (with 12.5 mM magnesium) and by 54% in the presence of 10 microM TTX. The systemic administration of PCP (7.5 mg/kg) or the local perfusion of PCP (100 microM and 1 mM) significantly inhibited the high potassium evoked GABA release in the rat striatum. The local perfusion of MK-801 (10 microM and 100 microM), a more potent and selective N-methyl-D-aspartate (NMDA) receptor antagonist, also inhibited the high potassium evoked striatal GABA release. These drugs did not show any significant effect on the basal extracellular GABA level. NMDA (1 mM) either partly or completely blocked the effect of PCP (1 mM) or MK-801 (100 microM) on the high potassium evoked striatal GABA release. On the other hand, nomifensine (100 microM), a dopamine uptake blocker, did not show any effect on the high potassium evoked GABA release. These results suggest that PCP inhibited the striatal GABAergic neuronal transmission through its antagonism of the NMDA receptor.