[Anesthetic management for pacemaker implantation of a child with hypertrophic cardiomyopathy and sick sinus syndrome]

A 5-year-old boy weighing 15 kg with hypertrophic cardiomyopathy and sick sinus syndrome was scheduled to undergo implantation of permanent pacemaker without a temporary intravenous pacemaker, because he frequently complained of chest pain and fell into syncope due to hypotension associated with tachycardia when he was agitated. Thus, the most important point in the anesthetic management of this patient was to avoid tachycardia prior to and during general anesthesia. After the patient was premedicated with oral pentobarbital 50 mg and intramuscular morphine 3 mg, he seemed to be calm in the operating room. General anesthesia could be smoothly induced and maintained with halothane, nitrous oxide and fentanyl. During anesthesia, inspired concentration of halothane was chosen on the basis of Q-F time (the time between Q wave on the electrocardiogram and the initial upstroke of arterial pressure wave). The anesthetic course was uneventful. In this case an appropriate preanesthetic medication appeared to be essential, and the measurement of Q-F time was useful for the anesthetic management.

Beige rat: a new animal model of Chediak-Higashi syndrome

Although Chediak-Higashi syndrome (CHS) has been found in various mammalian species, it has not been described in rats. Since giant granules characterizing CHS are easily recognizable in mast cells of beige (CHS) mice, we screened mast-cell granules in the auricle of some mutant rats, of which coat color was diluted by mutation. Giant granules of mast cells were found in a mutant trait that occurred in the inbred colony of the DA strain rat maintained in Hamamatsu University School of Medicine. Giant granules were also observed in neutrophils and pigment cells of the eye. In this mutant, either spontaneous migration or chemotaxis of neutrophils was impaired, and the bleeding time was prolonged. Blood serotonin level of the mutant was about one tenth that of the normal congenic rat, and injection of serotonin normalized the bleeding time of the mutant. Moreover, the natural killer activity of the mutant was significantly impaired. These results indicated that this mutation was comparable to CHS of humans and mice, and we designated it as "beige." Since rats are more favorable than mice for some types of experiments, the beige rat is potentially useful as an animal model of CHS.

[A case of Rothmann-Makai syndrome associated with mononeuropathy]

We reported the first case of Rothmann-Makai syndrome associated with mononeuropathy in a 31-year-old woman. In June 1989, she noticed several small subcutaneous nodules in the bilateral upper arms. On July 2, she woke up because of severe pain below the knee in the right leg which lasted 15 hours. On admission, subcutaneous nodules were recognized on bilateral upper arms, abdomen, gluteal regions and thighs. None of these nodules were associated with local heat or pain. Muscle weakness and dysesthesia were observed in the right foot, but deep tendon reflexes were normal. Electrophysiological studies revealed a decrease of the amplitude of action potential and of the conduction velocity in the right tibial nerve. Microscopic examination of skin biopsy showed lipolysis and diffuse lymphocyte infiltration (panniculitis) and perivascular lymphocyte infiltration was also observed. Routine laboratory data including peripheral blood, ESR, blood chemistry, and CRP were in the normal range and antinuclear antibodies and LE cells were not detected. By those findings, she was diagnosed as Rothmann-Makai syndrome associated with mononeuropathy. Steroid treatment was effective on both skin lesions and mononeuropathy. Steroid treatment was effective on both skin lesions and mononeuropathy. We concluded that this mononeuropathy may be induced by a ischemic change which may be caused by panniculitis.

Serologic differences in strains of Sporothrix schenckii

To obtain evidence that Sporothrix scheneckii enters the body by contact with contaminated materials, the antigenic property of strains from different sources was investigated. The reciprocal absorption test of the antisera against a soil isolate and a human isolate (KO 4606) showed that the absorbed antisera against KO 4606 possessed unique antigen(s) in addition to the common antigen of both strains. Twenty-three clinical isolates were tested with absorbed antisera. Not all of them possessed the unique antigen(s), but there were serologic varieties among S. schenckii strains, regardless of their sources, clinical type of the disease and the morphology of the yeast phase cells.

The effects of nicardipine on cerebrospinal fluid pressure in humans

The effects of nicardipine hydrochloride, a calcium channel blocker, upon cerebrospinal fluid pressure (CSFP) were investigated in 47 patients without intracranial pathology who were assigned to one of three groups: group 1 (n = 17), who received 0.01 mg/kg nicardipine, group 2 (n = 17), who received 0.02 mg/kg, and group 3 (n = 13), who received 0.03 mg/kg. A spinal needle was inserted into the subarachnoid space to permit continuous measurement of CSFP. Nicardipine produced statistically significant increases in CSFP: from a mean of 7.6 to 11.6 mm Hg in group 1, 7.2 to 12.2 mm Hg in group 2, and 7.4 to 13.8 mm Hg in group 3 (P less than 0.001 in each group). CSFP after nicardipine attained its maximum in 1-2 min, the gradually returned to control levels. Changes in CSFP were always associated with statistically significant decreases in arterial blood pressure and cerebral perfusion pressure, whereas the heart rate showed significant increases. Nicardipine may increase CSFP to undesirable levels in patients with intracranial hypertension.

[Quantitative analysis of 123I-BMIPP imaging in relation to exercise-redistribution 201Tl in patients with old myocardial infarction]

Myocardial kinetics of 123I-labeled 15-(p-iodophenyl)3R,S-methylpentadecanoic acid (BMIPP) was evaluated with BMIPP imaging in conjunction with stress-201Tl. We studied 20 patients with old myocardial infarction. BMIPP SPECT was obtained at 20 min and 3 h after injection. On a separate day, exercise stress-201Tl SPECT was performed at 10 min and 3 h after injection. Then, left ventricular myocardium was divided into 20 segments. For quantitative analysis, in each SPECT data, the maximum value (average counts per pixel) of all 20 myocardial segments was taken as 100%; the other values were calculated as a percentage of this maximum (Relative regional uptake, RRU). On the basis of stress-201Tl pattern, the myocardial segments were classified into 4 groups; normal 201Tl uptake, reversible 201Tl defect, fixed 201Tl defect and 201Tl defect with reverse redistribution. The 20 min BMIPP showed reduced activity compared with 3 h-201Tl (p < 0.001), especially in the area of 201Tl redistribution (50/111 segments, 45%), implicating impaired fatty acid utilization at resting condition. The washout rate of the segments with reversible 201Tl defect (-1.6 +/- 13.9%) was significantly lower than that of the segments with normal 201Tl uptake (9.0 +/- 9.8%) and fixed 201Tl defect (3.8 +/- 12.9%). Thus, BMIPP in combination with stress 201Tl imaging provides precise informations of impaired myocardial fatty acid utilization in patients with old myocardial infarction.

Clinical histopathological characteristics of basal cell carcinoma in Japanese patients

BACKGROUND

Basal cell carcinoma (BCC) does not commonly occur in the African and Asian races. Thus, there have been few reviews that have described the clinical overview of BCC among Japanese patients. There have been no large-scale analyses, including the histopathological features of BCC, except for the white race. We retrospectively examined 243 Japanese patients with BCC and analyzed the color of the tumors, the patient's age at which these tumors occurred, the site of the lesions, the histopathological patterns, and the incidence of recurrence and metastasis of the tumors; we compared these features with those in the other races statistically.

OBSERVATIONS

Clinically, approximately 75% of the tumors were pigmented and showed a so-called black pearly appearance. The male-female ratio was 0.97, and the average age of the patients was 59 years. Seventy-five percent of the tumors occurred on the head and neck. Fifty-four percent of the tumors showed a solid type of histopathological pattern. The incidence of recurrence and metastasis is extremely rare.

CONCLUSION

The high incidence of hyperpigmentation in the lesional skin of BCC is the most characteristic feature of BCCs in Japanese patients.

Basic and clinical studies on ApoE gene typing by line probe assay (LiPA) as a biological marker for Alzheimer's disease and related disorders: multicenter study in Japan

The fundamental reagent capability and clinical significance of ApoE gene typing has been investigated. The result of each test shows that the reagent capability satisfied the expected standard. Four-hundred thirty-nine samples classified into three groups (Alzheimer's disease (AD), other types of dementia and nondementia) were measured to examine the clinical significance. The rate of epsilon 4 genotype of each group was 31.5%, 14.6%, 10.4%, respectively. The AD group had a higher rate than the other groups (p < 0.001). The measurement of ApoE genotype is suggested to be useful as one of the guidelines in the diagnosis of AD.

[A study on the efficacy of combination chemoendocrine therapy consisting of cyclophosphamide, adriamycin, UFT, and tamoxifen for advanced or recurrent breast cancer]

The efficacy of the combination chemoendocrine therapy CAUT against advanced and recurrent breast cancer was examined. One course of this therapy lasted 3 weeks and consisted of adriamycin (i.v.) at 30 mg/m2 on day 1, cyclophosphamide (p.o.) at 65 mg/m2 and UFT (p.o.) at 300 mg/m2 on days 1-14, and tamoxifen (p.o.) at 20 mg/body on days 1-21. Twenty patients were enrolled, of whom 19 were eligible including seven with advanced cancer and 12 with recurrent cancer. One patient achieved CR, ten PR, three NC, and five PD, for a response rate of 58% (95% CI: 29-87%). The response rates according to type of lesion were 73% (8/11) for the soft tissue, 38% (3/8) for the bone, 20% (1/5) for the lungs and pleura, and 50% (2/4) for the liver. Adverse events with a severity of grade 3 or more included a reduction in WBC in six patients (31.6%), a reduction in RBC in one (5.3%), alopecia in four (21.1%), and severe general fatigue in one (5.3%). One patient experiencing a grade 4 reduction in WBC, and one of five patients experiencing a grade 3 reduction with a fever, recovered after treatment with G-CSF. The other four patients recovered following suspension of administration. This therapy is considered useful, exhibiting a high response rate and relatively slight adverse effects.

[Endogenous D-serine in mammalian brains]

It is well established that, like glycine and D-alanine, D-serine potentiates glutamate neurotransmission via the N-methyl-D-aspartate (NMDA) receptor by selective stimulation of its strychnine-insensitive glycine site and acts as a co-agonist of the glutamate receptor. D-Serine has been found to modify behavioral changes associated with higher brain functions such as memory, convulsion, anxiety, psychotomimetic-induced abnormal behavior and cerebellar ataxia. Interestingly, a substantial amount of free D-serine has been demonstrated in mammalian brains, although it has long been presumed that D-amino acids are uncommon in mammals. Free D-serine is predominantly concentrated in the brain with a persistent high content throughout life. The patterns of the regional variations and the postnatal changes in brain D-serine are closely correlated with those of the R2B subunit of the N-methyl-D-aspartate (NMDA) type excitatory amino acid receptor. Moreover, D-serine is released to the extracellular space and taken up into the brain homogenates, C6 glioma cells and primary culture of astrocytes of the rat cerebral cortex. Recently, the conversion of L-serine to its D-form by serine racemase has been suggested by in vivo and in vitro experiments. These data are consistent with the view that D-serine might be an intrinsic positive modulator of the brain NMDA receptor containing the R2B subunit and play a pivotal role in controlling behavioral expression in mammals.

Endotoxin induces severe inflammatory reactions with necrosis at sites primed with delayed-type hypersensitivity reactions in guinea pigs

Guinea pigs immunized with Freund's complete adjuvant received challenge injection of the purified protein derivative of Mycobacterium tuberculosis in the flanks and the corneas to prepare delayed-type hypersensitivity (DTH) reactions. The animals were injected subcutaneously with lipopolysaccharide (LPS) or a synthetic lipid A (LA-15-PP). At the skin site primed with DTH reaction, increased swelling and hemorrhagic reaction followed by a definite necrotic reaction occurred. Severe corneal reactions were also observed in the animals. These findings indicate that bacterial endotoxin modulates DTH reactions and induces severe inflammatory reactions.

Characterization of platelet abnormalities of Tester Moriyama (TM) rats with storage pool deficiency

Platelet abnormalities of Tester Moriyama (TM) rats, which have prolonged bleeding time with normal platelet count, were characterized by comparison with those of fawn-hooded (FH) rats with platelet storage pool deficiency (SPD). Morphologically, the dense granules were virtually lacking in platelets from TM and FH rats. Platelets from TM and FH rats aggregated in response to adenosine diphosphate (ADP), but failed to have secondary aggregation. In contrast, platelet aggregation was completely absent in response to 1 to 20 micrograms of collagen/ml, although partial aggregation was observed at the higher dosage of 50 micrograms/ml. Normal amounts of platelet membrane glycoproteins IIb/IIIa were expressed in TM and FH rats, but platelet adenosine triphosphate (ATP) and ADP contents were lower than those in platelets from control Wistar rats. Platelet ATP-to-ADP ratio of TM and FH rats was significantly higher than that of Wistar rats. Serotonin content in platelets from TM and FH rats was 20 to 25% that of Wistar rat platelets. These results suggested that platelet abnormalities of TM rats are a typical characteristic of platelet SPD and are similar to those of FH rats, which are genetically different from TM rats. Therefore, TM rats may serve as a useful animal model for the study of platelet SPD.

New approach to axial coupling constants in the QCD sum rule

We derive new QCD sum rules for the axial coupling constants by considering the correlation functions of axial-vector currents in a one-nucleon state. The QCD sum rules tell us that the axial coupling constants are expressed by nucleon matrix elements of quark-gluon composite operators which are related to the sigma terms and the moments of parton distributions. The results for the isovector axial coupling constants and the eighth component of the SU(3)(f) octet are in good agreement with experiment.

Effect on vein graft intimal hyperplasia of nuclear factor-kB decoy transfection using the second generation of HVJ vector

AIM

Vein graft stenosis due to intimal hyperplasia (IH) is the main cause of graft failure. We examined possibilities of nuclear factor-kB (NF-kB) expression in vein grafts, and inhibitive effects of NF-kB decoy on the gene expression and subsequent vein graft IH.

METHODS

Fifteen mongrel dogs underwent femoral artery replacement with autogenous vein grafts. Group I: grafts were retrieved at a predetermined time and subjected to NF-kB binding activity assay; Groups II and III: grafts were transfected with scrambled (II-a, III-a) or NF-kB (II-b, III-b) decoy using hemagglutinating virus of Japan envelope before implantation. Grafts were retrieved 7 days after implantation for evaluation of intercellular adhesion molecule-1 (ICAM-1) mRNA expression (Group II) and 4 weeks after implantation for comparison of IH by morphometric analysis (Group III).

RESULTS

NF-kB binding activity was increased in a time-dependent manner, with a peak 2 days after implantation. The ratio between ICAM-1 and glyceraldehyde-3-phosphate dehydrogenase mRNA expression in II-b was significantly lower than that in II-a (0.347 +/- 0.07 versus 0.612+/-0.08; P = 0.047). The ratio of intimal cross-section area to luminal cross-section area of III-b was significantly lower than that of the III-a (0.096+/-0.03 versus 0.461+/-0.11; P = 0.048).

CONCLUSION

NF-kB binding activity in vein grafts increases after implantation, and transfection of NF-kB decoy before implantation may reduce IH through the inhibition of ICAM-1 expression.

Cryopreservation of in vitro Shoot Tips of Ulluco (Ullucus tuberosus Cal.) Using D Cryo-Plate Method

　　BACKGROUND: Maintenance of in vitro collections of ulluco (Ullucus tuberosus Cal.) is cumbersome and costly in an ex-situ genebank. An alternative method for long term preservation which is safe and cost-effective is required.

OBJECTIVE

To apply a novel cryopreservation procedure using the cryo-plate system to improve the long-term conservation of ulluco.

MATERIALS AND METHODS

Initially V and D cryo-plate methods were tested, subsequently the D cryo-plate method was selected for ulluco cryopreservation. The D cryo-plate procedures were optimized for post-LN regrowth procedures including cold-hardening, sucrose addition in alginate gel, and duration of LS treatment. Optimized procedures were tested with 11 ulluco lines.

RESULTS

Shoot tips were isolated from cold-hardened shoots for 3-4 weeks at 5 degree C were excised to 1.0-1.5 mm long and 0.5 mm wide and precultured for 16h at 25 degree C on MS with 0.3 M sucrose. The shoot tips were attached on the cryo-plates by alginate gel with 0.4M sucrose. The cryo-plates with attached shoot tips were treated with 2.0 M glycerol and 1.0 M sucrose solution for 90 min at 25 degree C and dehydrated on filter paper in a Petri dish by air current flow at 25 degree C for 45 min before direct immersion in LN. This optimized procedure was applied to shoot tips of 11 ulluco lines, resulting regrowth ranging from 73 % to 97 %, with an average of 90 % post-LN regrowth.

CONCLUSION

D cryo-plate is a practical and simple procedure for cryo-storage of in vitro grown ulluco shoot tips in an ex situ genebank.