[Assessment of the practicability of coronary risk index as a screening method for ischemic heart disease in preoperative evaluation]

Coronary risk index (CRI) is our newly developed screening method for ischemic heart disease in preoperative evaluation. In this study, we assessed the practicability of CRI examining coronary angiograms (CAG) obtained in 106 patients scheduled for operations. CAG was rated with CAG score, then CRI and CAG score were statistically analyzed. These two parameters showed a significant positive relationship; the higher CRI, the higher CAG score (P < 0.0001). When the patients were divided into five groups by their CRI (0-9, 10-14, 15-19, 20-24, and more than 25), the group with higher CRI contained significantly more patients with severe multivessel coronary lesion (P < 0.0001). Similar results were obtained even in the patient with minimal change in ECG or exercise ECG, or those with minimal chest symptoms (P < 0.001). These results suggests that CRI works effectively as a screening method for ischemic heart disease regardless of abnormalities in ECG or the chest symptoms. More cautious perioperative management should be carried out in patients with higher CRI.

Enhanced metastasis of B16 melanoma cells by unexpected elevated expression of the metastasis-associated TI-241 (LRF-1-, Jun-Fos-related) gene treated with antisense oligonucleotide

B16-F10 is a B16 mouse melanoma subline that preferentially metastasizes to the lung following intravenous injection. Previously we isolated TI-241 (LRF-1 homologue related to Jun-Fos) gene that was expressed higher in the high metastatic clone B16-F10 than the low metastatic clone F1. Transfection of TI-241 into F1 converted it into a high-metastatic cell. We studied the effect of antisense oligonucleotide designed to reduce the expression of TI-241 in B16-F10 cells, and observed an unexpected increase in the TI-241 level. The increase in the expression was maximal at 30 h, then it decreased during further culture with or without TI-241 antisense oligonucleotide. This increased TI-241 expression by antisense oligonucleotide was also observed in B16-F1 cells whereas sense oligonucleotide did not affect the expression. B16-F10 cells cultured with TI-241 antisense oligonucleotide showed enhanced experimental metastatic potential to the mouse lungs compared with untreated B16-F10 and B16-F10 cultured with TI-241 sense oligonucleotide.

[Drug consultation and at home care--the present situation and the point at issue in our hospital]

We began drug consultation in our hospital and at home care about one year ago, because of progress in the quality of medical care. As the method for drug consultation, we tried to educate patients using our own pamphlets. It was assumed that the education was important not only for the patients but also for their family. Again, it was assumed that the usefulness of a conference with doctors, nurses, MSW and us made for better compliance in taking drugs, assured early detection of side effects and better management of the disease. With home care, it is supposed that the drug consultation will be carried out by clinical pharmacists will make for progress in the quality of medical care.

Precipitating factors in spontaneous recurrence of methamphetamine psychosis

This paper examines noradrenergic hyperactivity in response to stress in the development of spontaneous recurrences of methamphetamine (MAP) psychosis, a phenomenon known as flashbacks, in studies of psychedelic drug use. We studied predictors of flashbacks in 36 subjects with flashbacks, along with 80 subjects with a history of MAP psychosis who did not experience flashbacks. Plasma monoamine metabolite levels were assayed in 26 of the 36 subjects with flashbacks, 16 of the 80 subjects without flashbacks, nine subjects with persistent MAP psychosis, and 28 normal controls. None of the 28 controls became psychotic. A square root transformation was applied to all monoaminergic values, resulting in data nearly normally distributed. The subjects with flashbacks had been exposed to stressful events or threatening paranoid-hallucinatory states or both during previous MAP use. Most flashbacks occurred under conditions that provoked a mild fear of other people. Plasma norepinephrine levels were markedly increased during flashbacks. Thus, stressful experiences together with MAP use may have induced noradrenergic hyperreactivity to a mild stress, which in turn may elicit memories of MAP psychosis associated with stressful experiences. A mild fear of other people precipitated the flashbacks, including markedly increased noradrenergic activity. The results of this study suggest that noradrenergic hyperreactivity to a mild stress is a precipitating factor in spontaneous recurrences of MAP psychosis.

[Transition in nutritional management and the home care service system in our hospital]

During the past two years, Kaname-cho Hospital has been diligent in meeting the health care needs of its patients through its home care service. In nutritional management, considering the activity of daily living (ADL) and the burden of the family, gastrostomy and intravenous hyperalimentation (IVH) have been increased. Although we started with services provided by physicians, nurses, and medical social workers (MSW), recently clinical pharmacists and dieticians have entered our home care services. Due to the strong support of our staff, it is now possible for Kaname-cho Hospital to provide a very fine, efficient home care service.

Noradrenergic activity and spontaneous recurrence of methamphetamine psychosis

The process that triggers flashbacks due to previous methamphetamine (MAP) psychosis was studied in 28 flashbackers, along with 84 non-flashbackers with a history of MAP psychosis. We measured plasma monoamine metabolite levels in 12 of the flashbackers and eight of the non-flashbackers, along with 28 normal controls. Most flashbackers had undergone frightening experiences during previous MAP use. The dominant triggering factor was a mild fear of other people. Plasma norepinephrine (NE) levels in the 12 flashbackers were increased during flashbacks. Thus, MAP use associated with threatening experiences may have increased sensitivity to stressors, leading to the occurrence of flashbacks, including exaggerated noradrenergic activity.

Clinical courses of hypochondriac-cenesthopathic symptoms in schizophrenia

The systematic detailed clinical studies regarding bodily complaints in schizophrenics are relatively few. This paper focuses on the longitudinal courses of hypochondriac-cenesthopathic (H-C) symptoms in schizophrenia. From a group of 183 subjects meeting DSM-III-R criteria for schizophrenia, who were observed for at least 5 years, 81 patients with H-C symptoms were selected. The pattern of the appearance of their H-C symptoms was investigated. There was a near equality in the incidence of acute type and chronic type H-C symptoms. This was also the case for the early and tardive types. On the other hand, the complex type was more frequent than the simple type. When the H-C symptoms occurred in the acute stage, there existed accompanying symptoms as a rule. Among the six clinical courses (subtypes) of H-C symptoms, the most frequent was the acute-complex-early type, the least frequent was the chronic-simple-early type.

The role of subfractionation of alpha-fetoprotein in the treatment of pediatric surgical patients

Subfractionation of serum alpha-fetoprotein (AFP) is a useful method to discriminate between yolk sac tumors, hepatic malignancies, and benign liver diseases in adults but has not been validated in infants and children. AFP subfractionation was performed on AFP-positive sera from 73 infants and children. AFP subfraction profiles were classified into three common types: (1) yolk sac type, (2) hepatoblastoma type, and (3) benign hepatic type, according to the reactivity of individual AFP samples to lectins. In 68 of 73 samples (93.2%), AFP subfraction profiles were accurately classified into these three types, and an atypical AFP subfraction profile resembling the hepatoblastoma type was found in sera from five infants (6.8%). Differentiation between hepatoblastoma and hepatitis when patients are very young can be difficult. Subfractionation is more accurate when patients are older. This technique was found to be useful in the diagnosis of neonatal ovarian tumors, in recurrent hepatoblastoma/ yolk sac tumor with low serum AFP, and in the differential diagnosis of hepatic mass (malignancy versus hyperplastic nodule) in the liver with long-standing cholestasis. Estimation of serum AFP subfraction profiles facilitates the differential diagnosis of various AFP-positive pediatric diseases, such as hepatoblastoma, hepatoma, hepatitis or germ cell tumors. This test is inexpensive, can be carried out within 48 hours, and should be performed for the differential diagnosis of pediatric liver disease.

[Intercalation monitoring PCR(IM-PCR), its principle and application: quantitative monitoring of HCV RNA in the course of IFN therapy]

We developed intercalation-monitoring PCR(IM-PCR), a homogeneous quantitative assay of DNA/RNA by PCR in the presence of a fluorescent DNA intercalative dye, while monitoring the fluorescence intensity of the PCR reaction mixture in the course of PCR cycles. We demonstrated the application of this assay to quantify HCV RNA in serum samples from patients with chronic hepatitis C. This assay gave efficient and reproducible results in a clinically useful dynamic range below 10(6) copies of HCV RNA for interferon therapy.

Methamphetamine psychosis: spontaneous recurrence of paranoid-hallucinatory states and monoamine neurotransmitter function

We studied the process that triggers spontaneous recurrences of methamphetamine (MAP) psychosis, a phenomenon known as flashbacks, in 28 female patients who experienced flashbacks, by comparing them with 92 female nonflashbackers with a history of previous MAP psychosis. The study evaluated plasma monoamine neurotransmitter function in 12 of the 28 flashbackers and in 8 of the 92 nonflashbackers. Control data were obtained from 28 normal, healthy females composed of 13 MAP users and 15 nonusers, none of whom became psychotic. The 28 flashbackers had experienced significantly greater frequencies of threatening events and frightening paranoid-hallucinatory states during previous MAP abuse than the 92 nonflashbackers. The dominant triggering factor was a mild fear of other persons. Plasma norepinephrine (NE) levels were significantly higher in the 12 flashbackers during flashbacks than during periods of normalcy and were significantly higher than those in the 13 user and 15 nonuser control subjects. Plasma NE levels in the 12 flashbackers during periods of normalcy were significantly higher than those in the 13 user control subjects. The eight nonflashbackers had significantly higher NE levels than the 13 user control subjects. This suggests that an increase in peripheral noradrenergic activity may be related to the occurrence of flashbacks. The present study suggests that repeated MAP use with frightening experiences may induce sensitivity to psychosocial stressors. A mild fear of other persons may have actualized the encoded frightening memories associated with the frightening experiences via increased sensitivity to psychosocial stressors. Thus, flashbacks may have been caused through an increase in peripheral noradrenergic activity.

Monoamine neurotransmitter metabolites and spontaneous recurrence of methamphetamine psychosis

The present study was conducted to evaluate plasma levels of monoamine neurotransmitter metabolites in spontaneous recurrences of methamphetamine psychosis (i.e., flashbacks). The subjects were 50 physically healthy females comprised of 25 who experienced flashbacks (flashbackers), 18 who did not experienced methamphetamine psychosis, and 9 who were currently suffering from persistent methamphetamine psychosis. The control data were available from 28 normal healthy females, of whom 20 had previously abused methamphetamine (users) and 8 who had not (nonusers), none of whom had ever become psychotic. Plasma levels of norepinephrine (NE), dopamine (DA), and 5-hydroxytryptamine (5-HT), and their respective metabolites were assayed. Plasma NE levels were significantly higher in the 25 flashbackers during their flashbacks than during their periods of normalcy, and were significantly higher than those in the 20 user and 8 nonuser controls. Plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) levels during flashbacks were significantly higher than those in the 20 user controls. The nine subjects with persistent methamphetamine psychosis had significantly higher NE levels than the user and nonuser controls. The 16 nonflashbackers had significantly higher MHPG levels than the user controls. The present study suggests that an increase in peripheral noradrenergic activity is related to the occurrence of flashbacks.

Fluorescence detection of specific sequence of nucleic acids by oxazole yellow-linked oligonucleotides. Homogeneous quantitative monitoring of in vitro transcription

We have developed a fluorescent DNA probe, oxazole yellow (YO)-linked oligonucleotide complementary to a target DNA/RNA, which can enhance the fluorescence on hybridizing with a target nucleotide. We demonstrated the applicability of the YO-linked oligonucleotide probe to real-time monitoring of the in vitro transcription process of a plasmid DNA constructed containing the 5'-terminus non-coded region of hepatitis C virus RNA. In the process of in vitro transcription in the presence of YO-linked complementary oligonucleotide, the fluorescence of the reaction mixture showed a time-dependent linear increase corresponding to the generated target RNA product.

Antibody responses against Echinococcus multilocularis antigens in naturally infected Rattus norvegicus

Two Norway rats, Rattus norvegicus, were found to be naturally infected with Echinococcus multilocularis in Japan. One of them was simultaneously infected with at least three different sized metacestodes of Taenia taeniaeformis. These two R. norvegicus rats and another R. norvegicus naturally infected with T. taeniaeformis and Capillaria hepatica were examined to see if they showed any antibody responses against these two cestode parasites with the view to obtaining more information on the importance of rats as the intermediate host for E. multilocularis. These R. norvegicus showed very poor antibody responses against the two cestode species, although the Wistar rats, R. rattus, experimentally infected with a single smaller sized metacestode of T. taeniaeformis showed stronger responses not only against T. taeniaeformis but also against E. multilocularis. Therefore the three R. norvegicus naturally infected with E. multilocularis and/or T. taeniaeformis demonstrated virtually no immune response, at least against these cestodes.

A case of serotonin syndrome induced by concomitant treatment with low-dose trazodone and amitriptyline and lithium

We describe a patient treated with trazodone, amitriptyline and lithium carbonate who developed anxiety, restlessness, tremor, myoclonus, hyperreflexia, diaphoresis, rigidity and hyperthermia. The constellation of findings was diagnostic of serotonin syndrome. Although doses of trazodone and amitriptyline were relatively low, serotonin syndrome developed in this patient. It is suggested that the combination with lithium facilitated the effect of central serotonergic responses mediated by trazodone and amitriptyline.

Monoamine neurotransmitter function and spontaneous recurrence of methamphetamine psychosis

The process that triggered spontaneous recurrence of methamphetamine (MAP)-induced paranoid-hallucinatory psychosis, a phenomenon known as flashbacks, was studied in 41 subjects with flashbacks, along with 84 subjects with a history of previous MAP psychosis but no flashbacks. Plasma levels of norepinephrine (NE), dopamine, and 5-hydroxytryptamine, and their respective metabolites were assayed in 28 of the 41 flashbackers, 16 of the 84 non-flashbackers, 9 subjects with persistent MAP psychosis, and 28 healthy controls comprised of 20 MAP users and 8 non-users. None of the 28 controls had become psychotic. The 41 flashbackers had experienced significantly greater frequencies of threatening events and frightening paranoid-hallucinatory states during previous MAP use than the 84 non-flashbackers. The dominant factor that triggered flashbacks was a mild fear of other persons. The 41 flashbackers may have encoded threatening experiences as frightening images. Repeated MAP use with threatening experiences may induce sensitization to frightening images. Plasma NE levels during flashbacks were significantly higher than the levels during periods of normalcy, and the NE levels in the 20 user and 8 non-user controls. The 9 subjects with persistent MAP psychosis had significant higher levels of NE than the user and non-user controls. The 16 non-flashbackers had significantly higher MHPG levels than the user controls. The findings suggest that MAP use may induce changes at pharmacological levels in the process underlying sensitization to frightening images. We suggested that when the flashbackers experienced a mild fear of other persons, MAP-induced sensitization to frightening images may have been actualized. Thus, the flashbacks may have been caused through increased noradrenergic hyperactivity.

Role of renal dopaminergic activity on renal sodium-water metabolism in congestive heart failure

1. The role of the renal dopaminergic system in water-sodium metabolism in heart failure remains unclear. 2. In this study, the urinary free dopamine excretion (uDA), delivery of L-dopa to renal proximal tubules (plasma L-dopa x creatinine clearance (Ccr)), and the production of dopamine in the kidney [uDA/(plasma L-dopa x Ccr)] were investigated in patients with congestive heart failure (n = 30) and in normal controls (n = 12). In both groups, endogenous Ccr, urinary excretion of sodium (UNaV), fractional excretion of sodium (FENa), plasma noradrenaline concentration (pNA) and plasma L-dopa concentration were also estimated. 3. uDA, plasma L-dopa, delivery of L-dopa and dopamine production in the kidney showed successively lower values in congestive heart failure with progression in NYHA functional class. 4. UNaV (r = 0.458, P < 0.05) and Ccr (r = 0.539, P < 0.01) positively correlated with uDA. Linear correlations were found between left ventricular ejection fraction and uDA (r = 0.574, P < 0.01), pNA (r = -0.495, P < 0.01) or plasma L-dopa (r = 0.423, P < 0.05). 5. From these findings, it was suggested that (i) uDA was clearly suppressed in patients with CHF, and (ii) the possible mechanisms of its suppression might be due to decrease of delivery of L-dopa into the proximal tubules and suppressed production of dopamine from L-dopa in the kidney.

Plasma monoamine metabolites and spontaneous recurrence of methamphetamine-induced paranoid-hallucinatory psychosis: relation of noradrenergic activity to the occurrence of flashbacks

The relationship between monoamine neurotransmitter function and spontaneous recurrence of methamphetamine (MAP) psychosis, a phenomenon known as flashbacks, was studied in a group of incarcerated women. Plasma levels of norepinephrine (NE), dopamine, 5-hydroxytryptamine, and their respective metabolites were assayed in 28 flashbackers, 19 non-flashbackers with a history of previous MAP psychosis, and 9 subjects with persistent MAP psychosis. Control data were available from 61 physically healthy prisoners (41 MAP users and 20 non-users, none of whom became psychotic). The plasma NE levels of the 28 flashbackers during flashbacks were significantly higher than levels during periods of normality, and were significantly higher than those in the MAP user and non-user controls. Plasma 3-methoxy-4-hydroxyphenylglycol (MHPG) levels during flashbacks were significantly higher than those in the user controls. The nine subjects with persistent MAP psychosis had significantly higher NE levels than the user and non-user controls. The 19 non-flashbackers had significantly higher MHPG levels than the user controls. Plasma levels of 3-methoxytyramine and dihydroxyphenylacetic acid contributed to the NE levels in the flashbackers, in contrast to the findings in the control group. Noradrenergic systems may be compromised in the flashbackers, suggesting increased vulnerability to psychotic decompensation. These findings suggest that aggravation in peripheral noradrenergic hyperactivity may be an important factor in the occurrence of flashbacks.

237Np in hemp-palm leaves of Bontenchiku for fishing gear used by the Fifth Fukuryu-Maru: 40 years after "Bravo"

The alpha radioactive components in the Hemp-palm of Bontenchiku were determined with emphasis on the measurement low-level 237Np by alpha-ray spectrometry after chemical separation. Bontenchiku is a kind of fishing gear for long-line fishing used by the Fifth Fukuryu-Maru (Lucky Dragon). This gear was exposed to fallout from the second thermonuclear test explosion (Bravo) at Bikini Atoll in March 1954. The 237Np content in the Bontenchiku sample was determined to be 11.5 +/- 0.8 mBq g(-1), with an activity ratio of 237Np:239,240Pu and an atom ratio of 237Np:239Pu estimated to be (2.2 +/- 0.2) x 10(-3) and 0.42 +/- 0.04, respectively. The data showed the existence of a chain reaction of 238U and its ratio to be 237Np:239Pu, as well as the presence of 237U at the time of fallout from Bravo event in March 1954.

Anesthesia induced in pigs by use of a combination of medetomidine, butorphanol, and ketamine and its reversal by administration of atipamezole

OBJECTIVE

To develop an IM administrable anesthetic combination for pigs.

DESIGN

Use of a combination of atropine, medetomidine, butorphanol, and ketamine (MB-K) was evaluated as an anesthetic regimen and compared with that of a combination of atropine, xylazine, butorphanol, and ketamine (XB-K). Cardiorespiratory effects of MB-K combination and use of atipamezole as a means of reversing anesthesia induced by MB-K were examined.

ANIMALS

18 castrated, mixed-breed, specific-pathogenfree pigs, aged 8 to 15 (mean, 12.1) weeks and weighing 14.5 to 26.0 (mean, 19.6) kg. were studied.

PROCEDURE

Dosages of drugs used in this study were atropine, 25 micrograms/kg of body weight; medetomidine, 80 micrograms/kg; xylazine, 2 mg/kg; butorphanol, 200 micrograms/kg; ketamine, 10 mg/kg; and atipamezole, 240 micrograms/kg.

RESULTS

MB-K combination proved to be more effective than XB-K combination as an anesthetic combination. After quick and smooth induction by IM administration, MB-K-induced anesthesia was sustained for 98.8 +/- 22.5 minutes (mean +/- SD, 47.4 +/- 16.5 minutes by XB-K) with accompanying muscular relaxation (91 +/- 18 minutes) and loss of pedal (82 +/- 24 minutes) and laryngeal (75 +/- 19 minutes) reflexes. Loss of these reflexes was of significantly longer duration than the loss induced by XB-K, enabled tracheal intubation, and, thus, supported major surgery for at least 30 minutes after induction. Recovery from MB-K-induced anesthesia was smooth. MB-K combination had a slight stimulative effect on cardiovascular status, and a significant depressant effect on blood gas and acid-base status, but these effects were within biologically acceptable limits. Oxygen consumption of pigs under MB-K-induced anesthesia decreased significantly. MB-K-induced anesthesia could be effectively and quickly reversed by IM or IV administration of atipamezole.

CONCLUSIONS

The combination of medetomidine, butorphanol, and ketamine induces excellent surgical anesthesia in pigs, and results in moderate cardiorespiratory effects. A great advantage of the anesthetic regimen is that it can be effectively and quickly reversed by atipamezole.

CLINICAL RELEVANCE

Medetomidine, butorphanol, and ketamine-induced anesthesia is available for short-term major surgery in pigs.