Revascularization Using an Extracorporeal Pump for the Treatment of Cerebral Embolism in the Acute Stage. For Protection of the Brain Tissue from Irreversible Change due to Cerebral Embolism

SUMMARY

Object. For patients with cerebral embolism, we are using an extracorporeal pump to rev ascularize the more peripheral brain tissues far from the thrombus, proceeding the microcatheter beyond the thrombus, and dissolving the thrombus during a satisfactory time as required. Methods. As the critical cerebral blood flow is thought to be below 30 mlllOOglmin, in the case of middle cerebral artery occlusion at the Ml portion, over 15mllmin. of arterial blood is necessary to protect the brain tissue from irreversible change. One thousand and eight hundred mmHg (about 2 atoms) of pump pressure is necessary to send l5mllmin. of blood through the microcatheter (110 cm, FastTrucker 18, Boston). It was confirmed by laboratory and clinical data that hemolysis of the pump action is not sufficient to aggravate kidney function. Conclusion. This method enables the protection of brain tissues from irreversible change after cerebral embolism, and extends the time sufficiently for thrombolysis.

The embolization of ruptured aneurysms in acute stage

SUMMARY

We have treated 93 ruptured aneurysms with Guglielmi Detachable Coils (GDC) in acute period. Seventy-three patients (78%) were independent on discharge. Among the patient of Hunt and Hess Grade I, II and III, 59 patients (88%) were independent. Acute re-rupture occurred in two elderly patients with insufficient embolization and two patients experienced rerupture in the follow up period. Symptomatic vasospasm was reported in 17.6% of patients. The permanent morbidity rate is 4.4% and one patient died (1.5%). Although the long-term results remain to be determined, embolization with GDC is a safe and promising treatment for acutely ruptured aneurysms.

A study of the combination of gemcitabine hydrochloride (LY188011) and cisplatin in non-small-cell lung cancer: 3-week schedule

BACKGROUND

It has been reported that the combination of gemcitabine (LY188011; GEM) and cisplatin (CDDP) in a 4-week schedule showed a high response rate for patients with non-small-cell lung cancer (NSCLC), but GEM could not be administered on day 15 because of increased myelosuppression in many patients. The present study was performed to evaluate the efficacy and safety of GEM and CDDP in a 3-week schedule.

METHODS

Patients with unresectable NSCLC without prior chemotherapy were enrolled. We administered 1000 mg/m2 of GEM on days 1 and 8, and 80 mg/m2 of CDDP on day 1. The feasibility of the combination therapy was confirmed in 8 patients, and then 20 more patients were enrolled, to evaluate the efficacy and safety of this combination therapy for all 28 patients.

RESULTS

The response rate was 42.9% (12/28) and the median survival time was 12.6 months. Neutropenia, leukopenia, anemia, thrombocytopenia or lymphocytopenia of grade 3 or higher were observed as hematological toxicity, and anorexia, nausea, fatigue, or vomiting of grade 3 were the nonhematological toxicities, but most of these toxicities were of grade 2 or less. For GEM and CDDP, 89% and 91% of the scheduled doses, respectively, were administered.

CONCLUSION

This is the first study of the combination of GEM and CDDP with a 3-week schedule in Japan, and the results showed a low level of myelosuppression, high dose intensity, and high response rate, similar to the results reported in other countries. Accordingly, the combination of GEM and CDDP with a 3-week schedule may be a promising regimen for the treatment of NSCLC in Japan.

Effects of the extract of the bark of Magnolia obovata and its biphenolic constituents magnolol and honokiol on histamine release from peritoneal mast cells in rats

We have previously reported that saiboku-to, an Oriental herbal remedy composed of a mixture of 10 different herbal extracts, possesses anti-histamine release effect on mast cells in rats. This effect may be due mainly to the extract of the bark of Magnolia obovata (M. obovata), a constituent herb of saiboku-to. In the present study, it was demonstrated that the bark extract inhibited compound 48/80 (C48/80)-induced histamine release from mast cells in a concentration-dependent manner (50 % inhibitory concentration, IC(50) = 56.98 microg/ml). Furthermore, the inhibitory activity was found in the methanol fraction, but not in water and 50 % aqueous methanol fractions derived from the bark extract. Magnolol and honokiol isolated from the methanol fraction inhibited C48/80-induced histamine release from mast cells. The potency of magnolol (IC(50) = 1.04 microg/ml) was greater than that of honokiol (IC(50) = 2.77 microg/ml). Furthermore, the actual amount of magnolol (49.76 +/- 1.14 mg) contained in the bark of M. obovata (5 g) was greater than that (8.58 +/- 0.19 mg) of honokiol. Taken together, the present results suggest that magnolol may be responsible for the biological efficacy of the bark extract of M. obovata.

Increase of oligodendrocyte progenitor cells after spinal cord injury

The reaction of oligodendrocyte progenitor cells (OPCs) after spinal cord injury (SCI) is poorly understood. In this study, we examined oligodendroglial reactions after contusion SCI in adult rats by immunohistochemistry. OPCs were identified by staining with monoclonal antibodies (mAbs) A2B5 and O4. Each of the A2B5-, O4-positive OPCs and galactocerebroside-positive oligodendrocytes dramatically increased in the lesion of the dorsal posterior funiculus. Bromodeoxyuridine (BrdU) incorporation studies showed that most O4-positive cells in the lesion were labeled with BrdU, suggesting that these OPCs were proliferative. In contrast, the expression of myelin basic protein was decreased in the lesion compared with controls that received laminectomy only. From the injured cord, OPCs were isolated by immunopanning with mAb A2B5. We observed an increased number of OPCs from the injured spinal cords compared with those isolated from controls and unoperated animals. After several days in culture, the OPCs from the lesion expressed galactocerebroside. These results suggest that OPCs are induced and can differentiate following SCI in the adult rat.

Conservative management of placental polyp with oral administration of methotrexate

Surgical treatment is usually selected for placental polyp accompanied by massive bleeding but patients wishing to conserve their fecundity require conservative management. A 35-year old nullipara was diagnosed as having placental polyp on the basis of typical episodes, and detection of placental polypeptide hormones and blood flow by Doppler ultrasonography and dynamic magnetic resonance imaging. Oral administration of methotrexate (2.5 mg, three times a day for 5 days) was repeated for three cycles because surgical treatment was rejected. Serum human placental lactogen, blood flow and the polyp disappeared sequentially following chemotherapy. This report thus advocates considering conservative management for placental polyp.

Mitochondrial ATP-sensitive potassium channel plays a dominant role in ischemic preconditioning of rabbit heart

BACKGROUND

The ATP-sensitive potassium (K(ATP)) channel has been shown to be important in the ischemic preconditioning (IPC) response. Recently, the mitochondrial rather than the sarcolemmal K(ATP) channel has been focused on due to its energy-modulating property. Hence, this study was undertaken to elucidate the role of the mitochondrial K(ATP) channel in IPC by modulating the mitochondrial K(ATP) channel in isolated perfused rabbit hearts.

METHODS

Seven hearts served as a control with no interventions. Seven hearts underwent IPC consisting of two 5-min cycles of global ischemia followed by 5 min of reperfusion. Seven hearts received the selective mitochondrial K(ATP) channel blocker 5-dehydroxydecanoate (5-HD, 100 microM) for 5 min before IPC, and 7 hearts received the selective mitochondrial K(ATP) channel opener diazoxide (50 microM) for 5 min. Then, all hearts were subjected to 1 h of left anterior descending coronary artery ischemia and 1 h of reperfusion. Left ventricular pressures, monophasic action potentials and coronary flow were measured throughout the experiment and infarct size was detected at the end of experiment.

RESULTS

(1) The mitochondria-selective K(ATP) channel opener diazoxide reduced infarct size as compared to control (p < 0.05); (2) IPC reduced infarct size and preserved postischemic diastolic function as compared to control (p < 0.05), and (3) the mitochondria-selective K(ATP) channel blocker 5-HD reversed these effects.

CONCLUSION

The mitochondrial ATP-sensitive potassium channel may be a potential site of cardioprotection.

[A giant testicular tumor detected with dyspnea due to lung metastases: a case report]

A 19-year-old male presented with dyspnea. Clinical examination revealed the left infant-head-sized testicular tumor, multiple lung metastases and retroperitoneal bulky lymph node metastasis with marked elevation of serum lactic dehydrogenase (LDH) and alpha-fetoprotein. Left radical orchiectomy followed by the chemotherapy with etoposide and cisplatin (EP) for 4 cycles was performed. The tumor weighed 1,700 g, and was pathologically diagnosed as mixed germ cell tumor consisting of embryonal carcinoma and yolk sac tumor. After the treatment, the tumor markers were normalized with partial response (PR) of lung metastases and complete response (CR) of retroperitoneal lymph node metastasis. Thereafter, biopsy of lung metastases through video-assisted thoracoscopic surgery (VATS) was performed, and pathologically no viable cells were detected. Five months after the treatment, he was seized with convulsion due to brain metastasis with hemorrhage. Therefore, a surgical resection of brain metastasis and 2nd line chemotherapy with etoposide, ifosfamide and cisplatin (VIP) chemotherapy for 3 cycles was performed. The patient has been free of recurrence for 21 months after the 2nd line chemotherapy.

[The role of psychosomatic medicine in public health (hygieiology): an approach for lifestyle-related disease]

In the twenty-first century it has been hypothesized that lifestyle-related disease will account for more than 70% of all disease; thus, in the twenty-first the prevention and treatment of lifestyle-related disease will be of primary importance. Lifestyle differs from individual to individual. In the past preventive medicine has targeted groups while clinical medicine has dealt with disease. However, in the twenty-first century it will be necessary to integrate the two approaches to meet the needs of the individuals. Measures following the primary prevention of lifestyle-related disease will be the vital and they can only be delivered by primary care medicine. As a model that covers the prevention and treatment of lifestyle-related diseases, based on the conventional biomedical model, a systematic medical model that attaches importance to the relativity of all factors and individuality will be necessary. The medical model for psychosomatic medicine is the Bio-psycho-socio-ethical (ecological) model, and psychosomatic medicine has specific methods for implementing this model. We have used this perspective to explain the role of psychosomatic medicine in public health (hygieiology).

Inflammatory pathological changes in a 2-year-old boy with Charcot-Marie-Tooth disease

We report histopathological findings in a 2-year-old boy with Charcot-Marie-Tooth (CMT) 1A, which had some similarities to those of chronic inflammatory demyelinating polyneuropathy. These findings are unusual in adult CMT patients but are reported in some patients with corticosteroid-responsive hereditary motor and sensory neuropathy (HMSN) that are characterized by rapid worsening of symptoms. We administered betamethasone based on the inflammatory pathological features but no improvement was seen. Active demyelination is also reported as an early morphological feature in HMSN. It is probable that edema, active demyelination and a few onion bulb formations, which were recognized in this patient, are characteristic early histological changes of HMSN rather than those of corticosteroid-responsive HMSN.

Clinical evaluation of the Q-tip test in normal pregnant women

The crisis frequency of stress incontinence (SI) is known to be high among pregnant women. This preliminary study was performed to determine whether the diagnostic standard of the Q-tip test used in the diagnosis of SI in nonpregnant women is applicable to pregnant women. The Q-tip tests were performed regularly during pregnancy and after parturition on primipara (n = 71) and multipara (n = 55) who were not in SI crisis at any time during the pregnancy. The values measured in multipara were significantly higher than in primipara (p = 0.0001), and the tendency to be higher was more prominent at 2-5 months and 10 months of pregnancy. These findings show that different normal values of the Q-tip test are necessary for primipara and multipara.

Percutaneous transluminal angioplasty for atherosclerotic stenosis of the intracranial cerebral arteries. initial results and long-term follow-up

Percutaneous transluminal angioplasty (PTA) was carried out 52 times for 49 lesions in 47 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 21 cases, the basilar artery in eight cases, the internal carotid artery (petrous-supraclinoid portion) in 15 cases, and the intracranial vertebral artery in five cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 41 times. The initial success rate was 79% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 7 to 84 months with a mean of 44 months. During this period, death due to myocardial infarction or pneumonia occurred in five cases, stroke related to previous PTA occurred ih one case (due to re-stenosis) and stroke unrelated tl? previous PTA occurred in two cases. Angiographic follow-up was performed in 31 cases after 41 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomrltic complications occurred in 6%, and asymptomatic complications occurred in 6% of the cases. One case suffered severe subarachnoid hemorrhage just after the PTA due to preexisting aneurysm rupture and he died a week after the PTA. So mortality in this series was 2%. From the results described here, we may conclude that PTA of the intracranial or skull base cerebral artery is technically feasible, and it can be performed with relatively low risk. From our results, it may be a useful method and effective for long-term survival of patients. But results from a larger number of patients and more long-term follow-up data are still necessary in order to evaluate the safety and usefulness of this method.

An early experience of endovascular treatment for cerebral aneurysms harboring blebs

SUMMARY

Re-rupture of cerebral aneurysms often occurs at their blebs, and the treatment of cerebral aneurysms harboring blebs has been considered difficult. To prevent rupture during embolization, the authors have tried to deliver coils only into aneurysm domes, without inserting coils, a microcatheter, or a microguidewire into the blebs. Here, to prove such a treatment strategy, the authors report early experience in 3 cases with cerebral aneurysms harboring blebs.

Percutaneous Transluminal Angioplasty for Atherosclerotic Stenosis of the Intracranial Cerebral Arteries. Special reference to the device for reducing the complications drawn from the analysis of our complicated cases

SUMMARY

Percutaneous transluminal angioplasty (PTA) was carried out 43 times for 40 lesions in 38 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 15 cases, the basilar artery in seven cases, the internal carotid artery (petrous-supraclinoid portion) in 14 cases, and the intracranial vertebral artery in four cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 36 times. The initial success rate was 84% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 3 to 62 months with a mean of 40 months. During this period, death due to myocardial infarction or pneumonia occurred in four cases, stroke related to previous PTA occurred in one case (due to re-stenosis) and stroke unrelated to previous PTA occurred in two cases. Angiographic follow-up was performed in 30 cases after 36 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomatic complication occurred in 7%, and asymptomatic complications occurred in 7% of the cases. There was no mortality in this series. From analysis of complicated cases, there are several characteristic findings on the stenotic lesion. These are the stenotic lesions that located near the bifurcation, involving long segment, or showing irregular shape which is including ulcer or dissection. It is important to keep a fundamental and safe technique to reduce the complication. And besides, it is very important to keep the strict indication and to avoid the high-risk patient from a morphological point of view.

Effects of bezafibrate on insulin sensitivity and insulin secretion in non-obese Japanese type 2 diabetic patients

The aim of the present study was to investigate the effect of bezafibrate on insulin sensitivity and insulin secretion in 30 non-obese Japanese type 2 diabetic patients with hypertriglyceridemia (serum triglycerides > 150 mg/dL). Insulin sensitivity was measured with homeostasis model assessment insulin resistance (HOMA-IR) proposed by Matthews et al. HOMA-B-cell function, proposed by Matthews et al validated against minimal model-derived insulin secretion, was used to assess pancreatic insulin function. Twenty-two patients were treated with glibenclimide and the rest were treated with diet alone. All patients were treated with bezafibrate (400 mg/d) for 3 months. There were no changes in diet and the dose of any medications used throughout the study. Fasting glucose, insulin, triglycerides, HDL cholesterol, and total cholesterol levels were measured before and after treatment of bezafibrate. After treatment of bezafibrate for 3 months, serum triglyceride levels significantly decreased from 277 +/- 30 to 139 +/- 9 mg/dL (P <.001) and serum HDL cholesterol levels increased significantly from 45 +/- 2 to 52 +/- 2 mg/dL (P =.003). Serum cholesterol level was unchanged during the study (198 +/- 7 v 201 +/- 7 mg/dL, P =.383). Fasting glucose (163 +/- 8 v 139 +/- 6 mg/dL, P =.006) significantly decreased after the treatment with bezafibrate. HbA1c levels decreased, although not statistically significant (7.50 +/- 0.25 v 7.17% +/- 0.19%, P =.147). On the other hand, fasting insulin (9.3 +/- 0.7 v 7.3 +/- 0.5 microU/mL, P =.010) and HOMA-IR (3.61 +/- 0.24 to 2.53 +/- 0.20, P <.001) levels decreased significantly after the treatment with bezafibrate. In contrast, HOMA-B-cell function did not change during the study (41.4 +/- 5.5 v 41.8 +/- 4.7, P =.478). There was no significant difference in body mass index (BMI) levels before and after the therapy (23.0 +/- 0.4 v 23.1 +/- 0.4 kg/m(2), P =.483). From these results, it can be concluded that bezafibrate reduces serum triglycerides, insulin resistance, and fasting blood glucose levels in non-obese Japanese type 2 diabetic patients.

Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms

BACKGROUND

We propose to clarify the effect of umbilical arterial resistance on umbilical arterial blood flow patterns in normal pregnant women.

SUBJECTS

Pulsed Doppler examination was administered to 145 pregnant women of between 28 and 31 weeks of normal gestation without any prenatal complications.

METHODS

The arterial flow velocity waveforms from two different arteries, one in the intra-abdominal portion and the other at the placental insertion, were sampled with the color flow mapping method, and the peak systolic velocity and the resistance index were calculated.

RESULTS

The peak systolic velocity and resistance index on the placental side were significantly lower than those of the fetal side.

CONCLUSION

A major difference exists between the umbilical arterial flow velocity waveforms on the fetal and placental sides, which might be caused by difference in the umbilical arterial resistance.

Perception of hunger to insulin-induced hypoglycemia in anorexia nervosa

OBJECTIVE

We studied the effect of insulin-induced hypoglycemia on changes of hunger ratings in anorectic patients before and after cognitive-behavioral therapy.

METHOD

The subjects were 17 females with restricting anorexia nervosa at low body weight (AN-R), 6 anorectic patients whose weight was restored after cognitive-behavioral therapy (AN-T), and 11 age-matched female controls. All subjects gave hunger ratings by linear visual analog technique before and after insulin or saline injection.

RESULTS

Hunger ratings increased significantly 45 min after insulin injection in control females. However, ratings paradoxically decreased after insulin injection in AN-R females. They increased slightly after insulin injection in AN-T females, but the difference was not statistically significant. One-factor analysis of variance for the peak values of hunger ratings was significant. These values in control females were significantly higher than those in AN-R and AN-T females.

DISCUSSION

These results suggest that perception of hunger to insulin-induced hypoglycemia in AN patients is disturbed.