Basic neurophysiology of primate locomotion

To initiate and terminate bipedal and quadrupedal locomotor movements, a smooth transition to and from standing is necessary. For this, integration of postural and locomotor control systems is required. Recent studies in nonhuman primates and other quadrupedal animals such as cats have clearly shown that there exist significant analogies between the primate species investigated (Macaca mulatta, Macaca fascicularis, and marmosets) and the cats regarding the spinal stepping generator or central pattern generator (CPG), supraspinal descending pathways which activate CPG, and the midbrain and brain stem postural and locomotor control structures. Further studies aimed at elucidating the differences and similarities in the manner of locomotor control among different animal species will help us in understanding the control mechanisms involved in both bipedal and quadrupedal locomotor movements in nonhuman primates.

[Intraoperative use of plasma-derived activated factor VII (F VII a) in a hemophilia A patient with inhibitors]

We treated a 1-year 9-month-old boy with severe hemophilia A who developed high level of F VIII inhibitor. A placement of an implantable intravenous access device was scheduled under general anesthesia. After a slow induction using oxygen, nitrous oxide and sevoflurane, a peripheral venous line was placed and plasma-derived F VII a was infused. A catheter was inserted via the jugular vein to the SVC and it was connected to the device placed subcutaneously in his right chest wall. The peroperative blood loss was slight, and anesthesia and surgery went uneventfully.

Diffuse disorder of coronary artery vasomotility in patients with coronary spastic angina. Hyperreactivity to the constrictor effects of acetylcholine and the dilator effects of nitroglycerin

OBJECTIVES

We examined the vasomotility of the entire epicardial coronary artery system in patients with and without coronary spastic angina.

BACKGROUND

The coronary arteries of patients with variant angina are hyperreactive to diverse constrictor stimuli. It is unclear whether the abnormal responses to constrictive or dilative stimuli, or both, result from a localized or diffuse disorder in the coronary artery tree.

METHODS

Coronary artery diameter responses to intracoronary acetylcholine and nitroglycerin were examined at the proximal, middle and distal segments of three principal coronary arteries in 36 patients with coronary spastic angina without significant stenosis and in 12 young (< or = 30 years old) and 20 older control subjects (> 30 years old) with normal coronary arteriographic findings. In 10 patients with significant coronary stenosis, the responses of the prestenotic segments were also examined.

RESULTS

In patients with coronary spastic angina, coronary spasm was induced in 23 left anterior descending, 13 left circumflex and 17 right coronary arteries by acetylcholine. Multivessel spasm was observed in 15 patients. Acetylcholine had a dilator effect on most segments in young control subjects and a mild constrictor effect in older control subjects and in patients with significant stenosis. Comparison of the responses to acetylcholine among groups demonstrated that the constrictor response of the artery with spasm was enhanced significantly and diffusely. That of the artery without spasm also tended to be enhanced. Coronary artery diameters after nitroglycerin did not differ in any segment among patients with coronary spastic angina and both control groups. In patients with coronary spastic angina, nitroglycerin significantly enhanced dilation in all segments of the artery with spasm compared with that observed in both control groups and in most segments of the artery without spasm. Patients with significant coronary stenosis had a reduced response compared with that in control subjects.

CONCLUSIONS

Hyperreactive responses not only to the constrictor effects of acetylcholine, but also the dilator effects of nitroglycerin were detected diffusely in the epicardial coronary arteries of patients with coronary spastic angina. This finding indicates that a diffuse, not localized, disorder in vasomotility is involved in the pathogenesis of coronary spastic angina.

Effect of a novel histamine H2 receptor antagonist, IT-066, on acute gastric injury induced by ischemia-reperfusion in rats, and its antioxidative properties

The effect of a novel histamine H2 receptor antagonist IT-066 (3-amino-4-[4-[4-(1-piperidinomethyl)-2-pyridyloxy]-cis-2-++ +butenylamino]- 3-cyclobutene-1,2-dione hydrochloride), on acute gastric mucosal injury induced by ischemia-reperfusion was investigated from the standpoint of oxygen radical-mediated lipid peroxidation in rats. Ischemia-reperfusion injury was produced in the rat stomach by applying a small vascular clamp to the celiac artery for 30 min and subsequent removal of the clamp for 60 min. The decrease in gastric mucosal blood flow was not influenced by treatment with IT-066. The antiulcer activity of IT-066 was demonstrated in this injury after intragastric ingestion as well as after intravenous injection. IT-066 significantly inhibited this injury in the presence of exogenous HCl. The mucosal protection by IT-066 was not reversed by pretreatment with indomethacin or nitric oxide synthase inhibitor. The increase in lipid peroxides in the gastric mucosa after ischemia-reperfusion was significantly inhibited by the intragastric treatment with IT-066 at doses of 1.0 and 3.0 mg/kg. The total area of erosions closely paralleled the accumulation of lipid peroxide with a significant correlation. A spin trapping method using 5,5-dimethyl-1-pyrroline-N-oxide showed that IT-066 scavenged superoxide radical and hydroxyl radical generated by the hypoxanthine-xanthine oxidase system and the hydrogen peroxide-ferrous iron system, respectively. IT-066 also significantly inhibited the in vitro increase of lipid peroxide in the gastric mucosal homogenates induced by a free radical initiator. These results suggest that the protective effect of IT-066 against ischemia/reperfusion-induced gastric mucosal injury may result in part from its antioxidative properties.

Disappearance of giant negative T waves in patients with the Japanese form of apical hypertrophy

OBJECTIVES

The present study investigated the long-term changes in the electrocardiographic (ECG) hallmarks of the Japanese form of apical hypertrophy.

BACKGROUND

Giant negative T waves and tall R waves in the left precordial leads are the ECG hallmarks of the Japanese form of apical hypertrophy. However, the long-term course is largely unknown.

METHODS

Twenty-nine patients with apical hypertrophy (26 men, 3 women, mean age +/- SD 50.4 +/- 8.2 years) who showed left precordial giant negative T waves (< or = -10 mm) and tall R waves (> or = 26 mm) and spade configuration in the left ventriculogram were followed up for 10.9 +/- 3.7 years.

RESULTS

The intermediate follow-up ECGs (5 to 9 years) showed disappearance of giant negative T waves in 31% and of tall R waves in lead V5 in 6%. At the long-term follow-up study (> or = 10 years), loss of giant negative T waves increased to 71%, with average T wave negativity in lead V4 or V5 decreasing from -16.5 +/- 5.1 to -6.9 +/- 4.2 mm. These T wave changes were associated with decreases in R wave amplitude in lead V5 from 40.7 +/- 9.6 to 26.1 +/- 13.8 mm, with loss of tall R waves in lead V5 in 38% of patients and development of abnormal Q waves in two patients.

CONCLUSIONS

During the long-term follow-up of the Japanese form of apical hypertrophy, giant negative T waves disappeared in association with decreases in R wave amplitude in lead V5, indicating that these ECG hallmarks are clinical features that evolve progressively during the natural course of the disease.

Role of neutrophil-mediated inflammation in aspirin-induced gastric mucosal injury

The objectives of this study were to determine the roles of neutrophil-endothelial cell interactions and oxygen-derived free radicals in the pathogenesis of aspirin-induced gastric mucosal injury in rats. Oral administration of acidified aspirin (200 mg/kg) resulted in linear hemorrhagic erosions and an increase in myeloperoxidase activity, an index of neutrophil infiltration, in the gastric mucosa. Aspirin-induced gastric damage and the increase in myeloperoxidase activity were significantly inhibited by the injection of anti-CD11a, anti-CD11b, anti-intercellular adhesion molecule-1 monoclonal antibodies, and the combination of superoxide dismutase and catalase, which are scavengers of active oxygen species. These results suggest that neutrophil-endothelial adhesive interactions, which occur via CD11a/ CD18- and CD11b/CD18-dependent interactions with intercellular adhesion molecule-1, and oxygen-derived free radicals produced by neutrophils are implicated in the production of aspirin-induced gastric mucosal injury.

Risk assessment of adverse pulmonary effects induced by adrenaline beta-receptor antagonists and rational drug dosage regimen based on receptor occupancy

To clarify the beta-1 selectivity of beta-adrenergic receptor blocking agents (beta-blocking agents) after typical oral doses, the relationships between the effects on exercise heart rate or FEV1 and beta-1 or beta-2 receptor occupancies (phi 1, phi 2) of seven beta-blocking agents, acebutolol, atenolol, metoprolol, oxprenolol, timolol, propranolol, and pindolol were analyzed retrospectively. Nonlinear relationships between the pharmacologic effect and phi 1 and between the pulmonary adverse effect and phi 2 were obtained. Based on these findings, a new index of cardiovascular selectivity is proposed, given by the ratio of beta-1 receptor occupancy to beta-2 receptor occupancy (phi 1/phi 2). Using this new index, there was a little difference in beta-1 selectivity between acebutolol and pindolol (3.1:1.0), in contrast to a marked difference in beta-1 selectivity (320:1) as a conventional index between these two drugs. This finding indicates that even beta-1 selective drugs must be administered carefully to patients with pulmonary disease. Furthermore, the relationship between the pharmacologic or pulmonary effects and phi 1 or phi 2 has been analyzed quantitatively with a ternary complex model and used to develop rational dosage regimens for beta-1 selective beta-blocking agents, such as atenolol, to obtain the desired pharmacologic effects with minimum adverse pulmonary effects.

Effects of free radical scavengers on indomethacin-induced aggravation of gastric ulcer in rats

Effects of treatment with free radical scavengers in the healing process of acetic acid-induced gastric ulcer on the ulcer aggravation induced by indomethacin were investigated. Gastric ulcers were produced on the anterior wall of the stomach of male Sprague-Dawley rats by submucosal injection of 20% acetic acid. To investigate the role of oxygen radicals, rats with gastric ulcer were treated with scavengers for six weeks and then treated with indomethacin (1 mg/kg/day). While superoxide dismutase (10,000 units/kg/day) did not affect the ulcer area after indomethacin treatment, allopurinol (50 mg/kg/day) slightly inhibited the increase in ulcer area. Dimethyl sulfoxide (1% solution, ad libitum) produced a significant decrease in size of the ulcer after indomethacin treatment. Increased lipid peroxides in the gastric mucosa after indomethacin treatment decreased significantly in the rats of the dimethyl sulfoxide and allopurinol groups. These results indicate that lipid peroxidation mediated by oxygen radicals plays an important role in the mechanism of ulcer aggravation induced by indomethacin.

Arrest of cell growth by necdin, a nuclear protein expressed in postmitotic neurons

Necdin is a 325 amino acid residue protein localized to the nuclei of postmitotic neurons, which withdraw permanently from the cell cycle. To examine whether necdin confers the postmitotic phenotype, necdin cDNA was stably transfected into NIH3T3 cells, in which the protein was conditionally expressed using a eukaryotic lac repressor-operator expression system. When the transfectants were induced to express ectopic necdin, cell growth was arrested without appreciable reduction in cell viability. The expressed necdin molecule was localized to the nuclei of the transfectants. These results suggest that necdin is a nuclear factor that governs the permanent arrest of cell growth of postmitotic neurons during development of the nervous systems of vertebrates.

Fastigiofugal projection to the brainstem nuclei in the cat: an anterograde PHA-L tracing study

Fastigial projections to brainstem nuclei were studied using an anterograde neural tracer, Phaseolus vulgaris leucoagglutinin (PHA-L). Microinjections of PHA-L were made into the rostral pole, and middle and caudal parts of the left fastigial nucleus in cat. In addition to fastigioreticular and fastigiovestibular projections, fastigiofugal projections to cranial motor nuclei (IV, VI and VII) and those nuclei involved in autonomic control were identified. At the medullary level, a topographic arrangement of fastigioreticular projection was observed. Rostral and caudal parts of the fastigial nucleus projected to the ventral and dorsal parts of the medial reticular formation, respectively. Fastigiofugal fibers which originated from the rostral part of the fastigial nucleus innervated heavily the nucleus reticularis gigantocellularis (NRGc), nucleus reticularis magnocellularis (NRMc) and the ventral paramedian reticular nucleus (PRN). Those fibers from the middle part innervated heavily the ventrolateral vestibular nucleus (VLV), NRGc, NRMc, ventral and dorsal PRN and parasolitary tract nucleus. From the caudal part of the fastigial nucleus, projections to the cranial motor nuclei (IV, VI and VII), VLV and inferior vestibular nucleus were observed.

Early and late results of repair of tetralogy of Fallot with subarterial ventricular septal defect. A comparative evaluation of tetralogy with perimembranous ventricular septal defect

Between November 1966 and December 1990, 511 pediatric patients with tetralogy of Fallot underwent corrective operation at Tenri Hospital. There were 78 patients with subarterial ventricular septal defect. Mean age at repair was 5.6 +/- 3.3 years. The method of right ventricular outflow tract reconstruction was simple infundibulectomy in 14 patients, right ventricular ventricular outflow patch in 36, and transannular patch in 28. There were 7 (9.0%) early deaths as a result of low cardiac output syndrome and acute renal failure. The pressure ratio of the right ventricle to the left ventricle was 0.62 +/- 0.18 during the early postoperative catheterization. Follow-up was achieved for 442.6 patient-years and ranged from 0.5 to 27 years, with an average of 8.5 +/- 6.7 years. There were three late deaths (2 cardiac and 1 noncardiac). Actuarial survival was 94.8% +/- 4.0% at 20 years. Catheterization during late follow-up (6.8 +/- 4.7 years after repair) was done in 53 patients and the pressure ratio of the right ventricle to the left ventricle was 0.48 +/- 0.21. Fifteen patients underwent subsequent operation because of residual lesions, including ventricular septal defect in four patients, pulmonary stenosis in nine, combined ventricular septal defect and pulmonary stenosis in one, and pulmonary regurgitation in one, with no mortality. Actuarial rate of freedom from reoperation was 71.1% +/- 8.0% at 10 years and 58.8% +/- 16.8% at 20 years. Patients with tetralogy and subarterial ventricular septal defect were more likely to have the development of residual obstruction at the level of the pulmonary valve anulus after repair than were those with tetralogy and perimembranous ventricular septal defect.

A myosin missense mutation, not a null allele, causes familial hypertrophic cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is characterized by myocardial hypertrophy of unknown etiology. Missense mutations of the cardiac beta-myosin-heavy-chain (beta-MHC) gene that may be responsible for cardiac hypertrophy have been detected in patients with HCM. On the other hand, gross structural abnormalities in the cardiac beta-MHC gene, ie, an alpha/beta hybrid gene and partial deletion of the gene, have also been reported. The direct correlation between gross abnormalities and development of HCM is not well understood.

METHODS AND RESULTS

We analyzed the structure of the cardiac beta-MHC gene from patients with HCM by using polymerase chain reaction-DNA conformation polymorphism analysis and found two sequence variations in exons 3 and 22 in one patient. These sequence variations at codon 54 (exon 3; nonsense mutation) and codon 870 (exon 22; Arg-to-His mutation) were identified by direct sequencing and dot-blot hybridization with allele-specific oligonucleotide probes. Relatives of this patient were examined for the mutations. It was revealed that the missense mutation was inherited from the affected father and the nonsense mutation from the unaffected grandmother through the unaffected mother. In addition, the missense mutation was also found in seven other patients from two other unrelated multiplex HCM families.

CONCLUSIONS

The Arg870His mutation was suggested to cause HCM. In contrast, the gene with the nonsense mutation would encode for a cardiac beta-MHC protein of only 53 amino acid residues, which may be too short to be incorporated into the thick filament assembly of cardiac myosin chains and showed no dominant phenotype of heart disease. This is the first report of a nonsense mutation in the human cardiac beta-MHC gene.

Comparison of secretion pattern between A-type and B-type natriuretic peptides in patients with old myocardial infarction

OBJECTIVES

The present study was designed to compare the secretion patterns of two cardiac hormones--A-type (atrial) and B-type (brain) natriuretic peptides--from the ventricles in patients with old myocardial infarction.

BACKGROUND

Plasma levels of these two natriuretic peptides are increased, and their secretion from the ventricles is augmented, in patients with congestive heart failure.

METHODS

We measured the plasma levels of these two types of natriuretic peptides at the aortic root and the anterior interventricular vein in 42 patients with old myocardial infarction (anterior in 22 and inferior in 20) and 18 control subjects.

RESULTS

The difference between the plasma levels of both A- and B-type natriuretic peptide in the anterior interventricular vein and aortic root was significantly greater in the groups with anterior and inferior infarction than in the control group (A-type [mean +/- SD] 380 +/- 290 and 247 +/- 205 pg/ml in the infarction groups vs. 11 +/- 14 pg/ml; B-type 497 +/- 445 and 75 +/- 73 pg/ml vs. 23 +/- 16 pg/ml, respectively). The difference between the plasma levels of each peptide at the anterior interventricular vein and aortic root had a significant negative linear correlation with left ventricular ejection fraction in both groups with infarction. The slope of the regression line of the arteriovenous difference of B-type natriuretic peptide at the anterior interventricular vein was significantly steeper in the anterior than in the inferior infarction group (left ventricular ejection fraction -12.801 vs. -1.891, p < 0.01).

CONCLUSIONS

These results indicate that 1) the secretion of A- and B-type natriuretic peptide from the left ventricular increases in proportion to the severity of left ventricular dysfunction, and 2) secretion of B-type natriuretic peptide is much greater from the infarct than from the noninfarct region, suggesting that the regional ventricular wall stretch caused by infarction strongly stimulates secretion of B-type natriuretic peptide.

Effects of brain (B-type) natriuretic peptide on coronary artery diameter and coronary hemodynamic variables in humans: comparison with effects on systemic hemodynamic variables

OBJECTIVES

This study attempted to clarify the effects of human brain (B-type) natriuretic peptide on coronary artery diameter and coronary vascular resistance in humans.

BACKGROUND

Brain natriuretic peptide induces vasodilation in systemic circulation by activating particulate guanylate cyclase of the vascular smooth muscle.

METHODS

In 13 patients with normal coronary arteries and left ventricular function, brain natriuretic peptide was infused at 0.5 microgram/kg body weight per min for 4 min into the left main coronary artery (six patients, Group A) or into the pulmonary artery (seven patients, Group B). Systemic hemodynamic variables and coronary sinus blood flow were measured before and after the infusion. The lumen diameter of the left coronary artery was quantitatively measured.

RESULTS

In both groups, brain natriuretic peptide significantly increased heart rate and decreased mean arterial pressure. Rate-pressure product remained unchanged in both groups. Brain natriuretic peptide decreased systemic vascular resistance index significantly in both groups (both p < 0.01 vs. baseline), and there was no difference in the effect between the groups. Brain natriuretic peptide decreased coronary vascular resistance in Group A (p < 0.01 vs. baseline) but did not affect coronary vascular resistance in Group B (p < 0.01 vs. Group A). The lumen diameters of the proximal and distal segments of the left coronary artery were increased significantly after brain natriuretic peptide in both groups. After infusion of brain natriuretic peptide, mean plasma level of brain natriuretic peptide in the coronary sinus increased from 36 to 130,411 pg/ml in Group A and from 64 to 12,329 pg/ml in Group B.

CONCLUSIONS

Brain natriuretic peptide shows a vasodilator effect on the coronary artery system in humans. However, the effect does not appear uniformly but is seen preferentially in the epicardial coronary artery. The sensitivity of the coronary resistance vessels to brain natriuretic peptide is low compared with that of the resistance vessels of the systemic circulation.

A new gastric ulcer model in rats produced by ferrous iron and ascorbic acid injection

We developed a new gastric ulcer model in which the ulcers are induced by the local injection of a ferrous iron and ascorbic acid (Fe/ASA) solution into the gastric wall. These ulcers resemble human gastric ulcers that penetrate the muscularis mucosa. The involvement of oxygen radical-mediated lipid peroxidation as the cause of these ulcers was investigated. With ferrous iron or ascorbic acid alone, gastric ulcers did not form, whereas penetrating ulcers were produced by the simultaneous injection of the Fe/ASA solution in a dose-dependent manner. Lipid peroxides significantly accumulated in the gastric mucosa from 1 to 24 h after the injection of the Fe/ASA solution. This increase in lipid peroxides preceded grossly evident gastric ulcer. Treatment with superoxide dismutase (SOD, recombinant human CuZnSOD) significantly reduced the size of the ulcers and inhibited the accumulation in lipid peroxides in the gastric mucosa, while treatment with apo-SOD or heat-inactivated SOD did not. These results suggest that lipid peroxidation mediated by oxygen radicals plays a crucial role in the pathogenesis of the gastric ulceration induced by the Fe/ASA solution.

[Report of a severely deformed and calcified equine pericardial patch using for intracardiac repair of tetralogy of Fallot]

An 11-year-old boy with tetralogy of Fallot had undergone palliative right ventricular outflow tract reconstruction twice previously. After the second palliative surgery recurrent mediastinitis persisted. At the age of 5 years and 11 months, he underwent closure of VSD and reconstruction of the right ventricular outflow tract with an equine pericardial patch after removal of the infected prosthetic material. The postoperative course was uneventful, however, severe pulmonary stenosis developed 6 years later. The stenosis was caused by the severely deformed and calcified equine pericardial patch used for intracardiac repair. The reason for severe calcification seemed to be the accentuated calcium metabolism in children, hemodynamic stress and persistent infection.

Postnatal development of locomotor movements in normal and para-chlorophenylalanine-treated newborn rats

The contribution of the serotonergic system to postnatal development of locomotor movements in newborn Sprague-Dawley rats was studied from PND 1 to PND 15. To deplete serotonin (5-HT), p-chlorophenylalanine (PCPA) (200 mg/kg) was intraperitoneally administered at PND 1, 4, 7, 10 and 13, and the results obtained from PCPA-treated pups (n = 20) and control pups (n = 20) were compared. Locomotor movements of the pups on the surface of a digitizer table were measured by attaching a miniature coil to the abdomen of the pups. Video-recordings were made to study the locomotor movements. From PND 1 to PND 5, no significant difference in body weights and locomotor movements was observed across control and PCPA-treated pups. After PND 6, the development of PCPA-treated pups was slightly retarded although both groups of pups opened their eyes at PND 14. Throughout PND 6 to PND 15, the total distance and mean velocity of locomotor movements were significantly lower in PCPA-treated pups than in the control pups. In addition, forelimb and hindlimb movements were not well coordinated in the former. These results suggest that retardation of locomotor movements in the PCPA-treated pups is due to a possible failure in the postnatal development of 5-HT and other neural mechanisms related to postural and locomotor control, and not due to that of general development of the pups themselves.

Mitral valve replacement with a collar-reinforced prosthetic valve for disrupted mitral annulus

The mitral valve was replaced with a collar-reinforced prosthetic valve in 6 patients with a disrupted mitral annulus, in 3 because of infective endocarditis, including 2 patients with prosthetic valve endocarditis, in 2 because of a severely calcified mitral annulus, and in 1 who had previously undergone mitral valve replacement twice. Four patients had undergone prior mitral operations; these consisted of mitral valve replacement in 3 patients and mitral valve repair in 1. In all patients, the prosthesis was secured by double-layered sutures, with the first row of buttressed sutures passing through the leaflet or sutured to the left ventricular muscle and through the sewing cuff of the prosthetic valve. The second row of running sutures was then placed through an extended annular equine pericardial cuff of the prosthetic valve and the supraannular left atrial wall. In 2 patients, all chordae tendineae were preserved to maintain annulopapillary muscle continuity. All patients survived and have remained well for a mean of 22.3 months. There has been no prosthetic valve dehiscence, except for minimal paraprosthetic leakage in 1 patient. These results demonstrate that mitral valve replacement in patients with a disrupted mitral annulus can be successfully accomplished with a collar-reinforced prosthetic valve.

In vivo microdialysis for pharmacokinetic investigations: a plasma protein binding study of valproate in rabbits

The use of microdialysis to study the binding of valproate (VPA) to plasma proteins was evaluated in rabbits. Prior to an in vivo microdialysis, in vitro relative recovery of VPA respectively from Ringer's solution, 5% (w/v) of albumin solution and plasma sample via a microdialysis probe was examined. The in vitro relative recovery was defined as a ratio of the VPA concentration determined in the dialysate to the free VPA concentration in the sample solution surrounding the membrane of the microdialysis probe. When the sample solution was well stirred at 700 rpm and maintained at 37 degrees C, the in vitro relative recovery of VPA was significantly different among them. It increased in the order of Ringer's solution (34.3 +/- 2.6%) > 5% (w/v) of albumin solution (25.7 +/- 4.6%) > rabbit plasma sample (15.8 +/- 1.2%). Thereafter, pharmacokinetics of VPA was determined using both microdialysis sampling via the rabbit femoral vein and collection of whole blood via the rabbit ear vein after intravenous administration of VPA at a dose of 43 mg/kg. Free concentrations of VPA in plasma were determined by ultrafiltration method as opposed to microdialysis method. There was no difference in the elimination half-life of VPA determined by microdialysis, 1.09 +/- 0.22 h, or ultrafiltration, 1.22 +/- 0.21 h. The AUC of VPA in dialysate was 15 +/- 4 micrograms.h/ml, which corresponded to 15% of that in ultrafiltrate (103 +/- 17 micrograms.h/ml). The value was in good agreement with the in vitro relative recovery of VPA from plasma sample (15.8 +/- 1.2%).(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo microdialysis for the transdermal absorption of valproate in rats

The suitability of sampling via microdialysis for a lipophilic drug, valproate (VPA), was evaluated by the elimination rate constant of VPA solution in an in vitro experimental first-order elimination system. The elimination rate constant of VPA in dialysate was found to be 0.43 +/- 0.05h-1, which was in good agreement with the real elimination rate constant (0.46 +/- 0.02h-1). A change in VPA concentration in the solution surrounding a microdialysis probe was well maintained by the microdialysis method, suggesting no adsorption between the membrane of the microdialysis probe and VPA. On the basis of the in vitro experiment, the effect of a penetration enhancer, 1-[2-(decylthio)ethyl]azacyclopentan-2-one (HPE-101), on the transdermal absorption of VPA was examined in rats by the use of microdialysis in vivo. An intradermal microdialysis was performed at a flow rate of 1.0 microliter/min for 7h after the dermal application of 50 mM VPA solution with or without 3% (w/v) HPE-101. HPE-101 increased the transdermal absorption rate of VPA by 80 times compared with the control. The microdialysis system was found to be quite useful for assessing the in vivo transdermal absorption of a lipophilic VPA.

Protective effect of continuous retrograde cerebral perfusion on the brain during deep hypothermic systemic circulatory arrest

Deep hypothermic circulatory arrest has been widely used as an adjunct for surgery of the aortic arch to protect the brain and other vital organs. We introduced the use of continuous retrograde cerebral perfusion via the superior vena cava during deep hypothermic circulatory arrest in 1987 and have used it in 33 patients. Continuous retrograde cerebral perfusion times ranged from 10 to 89 minutes (mean 40.2 +/- 22.5), and minimal nasopharyngeal temperatures ranged from 14 to 25 degrees C (mean 17.4 +/- 2.0). Two patients with a ruptured aneurysm died during operation due to bleeding and two other patients, with continuous retrograde cerebral perfusion time of 24 and 35 minutes, died 1 month postoperatively due to preoperative liver cirrhosis and sepsis. Two patients suffered from stroke. The remaining 27 patients, including 6 with from 60 to 82 minutes of continuous retrograde cerebral perfusion, had no complications related to continuous retrograde perfusion. During continuous retrograde cerebral perfusion, 66 pairs of blood samples from the perfusate and from the drainage back to the arch vessels were obtained. Analysis of these samples revealed that partial pressure of oxygen, saturation of oxygen, and oxygen content significantly decreased (p < 0.001), and partial pressure of carbon dioxide (CO2) and CO2 content significantly increased (p < 0.001). The nasopharyngeal temperature gradually increased at the rate of 0.01 to 0.03 degree C/min, but was maintained below 20 degrees C. These results reflect the fact that the aerobic metabolism of the brain is maintained during continuous retrograde cerebral perfusion due to oxygen and substrate availability. This technique offers the potential of metabolic support to the brain during deep hypothermic circulatory arrest and prolongs the safe time limits of deep hypothermic circulatory arrest in surgery of the aortic arch.

Development of in vitro matured and fertilized bovine embryos cultured in media containing human leukemia inhibitory factor

Three experiments were conducted to evaluate the effect of addition of human leukemia inhibitory factor (hLIF) to synthetic oviduct fluid medium (SOFM) supplemented with human serum (HS), bovine serum albumin (BSA) or polyvinyl alcohol (PVA) on the development of bovine embryos matured and fertilized in vitro. In vitro matured and fertilized bovine oocytes were cultured in SOFM supplemented with 10% HS to obtain embryos at 1 - cell, 4 - or 8 - cell, and morula or early blastocyst stages. In Experiment 1, embryos at the different developmental stages were cultured in SOFM supplemented with 10% HS and 1 of 6 different dosages (0, 500, 1000, 2000, 4000, 6000 U/ml) of hLIF. In Experiments 2 and 3, the embryos were cultured in SOFM + BSA and SOFM + PVA, respectively with or without hLIF (5000 U/ml). In, Experiment 1, the addition of any hLIF dosages did not improve development to the expanding blastocysts as compared with the control (without hLIF) in each embryonic stage. Embryonic stages at the time of hLIF addition affected the development; early blastocysts resulted in significantly (P<0.01) better development than the other stages. The addition of hLIF at 1 -, 4 - and 8 - cell stages in Experiment 2 and 3 had no effect on development to the expanding blastocyst stages significantly (P<0.01) improved the development. The results indicate that the effect of hLIF addition is critical to embryonic stages and the advantage of hLIF addition is only observed when SOFM is supplemented with BSA or PVA. A stimulating effect of hLIF was not observed when SOFM was supplemented with HS.

Reduction of homologous blood transfusion in reoperative valve surgery

From April 1979 to October 1993, 126 adult patients underwent reoperative cardiac valve surgery. Patients were divided into two groups: 53 patients who underwent surgery before January 1990 (group 1) and 73 patients who underwent surgery after January 1990 (group 2). After January 1990, a clinical strategy for reducing homologous blood transfusions was implemented, including the use of predonation of autologous blood in the operating room, reduced heparin doses, an elevated threshold of indication for blood transfusion, and autotransfusion of shed, drained blood after surgery. In group 1, 44 patients (93.0%) received an average of 3785 +/- 1251 ml of homologous blood transfusions. In group 2, only 26 patients (35.6%) needed homologous blood transfusions and had a smaller amount (2985 +/- 1521 ml) on average. Furthermore, only seven patients needed fresh blood transfusion in group 2.

Successful repair of the right atrial isomerism, double outlet right ventricle, common atrioventricular canal, pulmonary stenosis, and total anomalous pulmonary venous connection

A 6-year-old boy was successfully operated on for double outlet ventricle, common atrioventricular canal with severe valvular regurgitation, right atrial isomerism, L-loop ventricles, total anomalous pulmonary venous connection, and pulmonary stenosis with hypoplastic left pulmonary artery. The interventricular rerouting from the left ventricle to the ascending aorta was performed with a spiral patch, the interatrial switching was performed by a Mustard patch, the common atrioventricular orifice was partitioned and valve repair was performed, and an 18-mm valved conduit was inserted between the right ventricle and the pulmonary artery. Although the patient had a small residual ventricular septal defect and pulmonary stenosis, the patient is alive and well.