Effect of selective PEEP on pulmonary blood flow following unilateral hydrochloric acid aspiration in the dog

We investigated the effect of unilateral or bilateral positive end-expiratory pressure (PEEP) on pulmonary perfusion in 12 dogs with a hydrochloric acid aspiration injury of the left lung. The lungs were ventilated separately and PEEP was applied to the left lung at 10 cmH2O (1.0 kPa) in six and at 15 cmH2O (1.5 kPa) in six others. Measurements of the right and left pulmonary arterial blood flows (QR and QL) and venous admixture were made before, during and after PEEP. After this study, 5 and 10 cmH2O (0.5 and 1.0 kPa) PEEP were applied to both lungs in six dogs and measurements were repeated. Following the application of PEEP to the left lung, a significant decrease in QL and increase in QR were observed. However, the application of PEEP to both lungs was followed by significant decreases in both QL and QR. The cardiac output decreased slightly during unilateral PEEP and markedly during bilateral PEEP. The venous admixture decreased significantly during PEEP in all the groups. These findings indicate that selective PEEP causes a transfer of pulmonary blood flow from the injured lung to the normal lung, improving ventilation-perfusion inequality, and improves gas exchange without impeding oxygen delivery.

Treatment of HBeAg-positive chronic hepatitis with a streptococcal preparation (OK-432)

Forty-two patients with hepatitis Be antigen (HBeAg)-positive chronic hepatitis were treated by intramuscular injections with OK-432, an immunopotentiator possessing interferon-inducing activity. They were monitored with serial measurements of virological parameters to evaluate therapeutic effectiveness, and compared with a group of seventy-five untreated patients (natural course group). In the group receiving OK-432 therapy, twenty-seven patients (64.3% of the forty-two patients) became negative for HBeAg in an average observation period of 20.1 months. Of these, fourteen patients (33.3% of the forty-two patients) underwent seroconversion from HBeAg to anti-HBe antibody (anti-HBe). In the natural course group, twenty-three patients (30.7% of the seventy-five patients) lost HBeAg reactivity in a mean follow-up period of 32.3 months, and thirteen patients (17.3% of the seventy-five patients) became seroconverted. Thus, the drug group showed significantly higher percentages of patients with disappearance of HBeAg and seroconversion, notwithstanding the shorter duration of the follow-up. Young males and females, females generally, or patients with high serum GPT levels were more likely to respond to the therapy. The serum GPT level tended to stabilize more in patients receiving OK-432.

Therapeutic effects of tiopronin on chronic hepatitis: a double-blind clinical study

The efficacy of tiopronin (2-mercaptopropionyl glycine) 600 mg daily in the treatment of chronic active or chronic persistent hepatitis has been assessed in a double-blind controlled clinical trial of 12 weeks involving 165 Japanese patients with histologically proven disease. Treatment with the drug was associated with a significant improvement in abnormalities of serum transaminase and gamma glutamyl transpeptidase, with reversion towards baseline values on stopping the drug. Improvement was independent of the histological classification of the disease, or HBsAg status. The drug was well tolerated with few side-effects. The results of this short-term study indicate that tiopronin may be of value in the treatment of chronic hepatitis.

[Serum and urinary level of sodium piperacillin in patients with liver disease (author's transl)]

Serum and urinary levels of PIPC (sodium piperacillin) in patients with liver disease were investigated. Serum and urinary levels of PIPC are affected by the degree of liver disease which is estimated most exactly by KICG, and it is available for determination of dose and administration interval. When PIPC was administered intravenously at a dose of 2 g, serum level in patients with liver disease was showed high and prolonged. Therefore this is convenient for PIPC of which biological half life is comparatively short. In patients with serious liver cirrhosis, PIPC is probably cumulated by continuous administration and in this case, dose and administration interval will be needed to regulate.

A study on the relationship between the prognosis of chronic active hepatitis and the HBV associated antigen/antibody systems

The relationship between the prognosis of the disease based on liver histology and HB virus (HBV) associated antigen/antibody systems was investigated in twenty seven patients with chronic active hepatitis (CAH). These patients were followed up over extended periods with mean duration of 44.3 months. On initial liver biopsy five of twelve patients with CAH with spotty or focal necrosis were HBs antigen (HBsAg) positive, as were also five of six patients with sublobular necrosis and six of nine patients with lobular disorganization. Most of the HBsAg negative patients were anti-HBs or anti-HBc positive: HBV associated antigen or antibody was completely undetectable in only three of the twenty seven patients. There was no difference in the frequency of progression to liver cirrhosis (LC) between the sixteen HBsAg positive and the eleven HBsAg negative patients with CAH. On the other hand, progression to LC occurred in only one of seven HBe antigen (HBeAg) negative patients, compared to four of nine HBeAg positive patients, who were HbsAg positive. There were four patients who were HBeAg positive initially but then became HBeAg negative in the course of observation. LC developed in two of these four patients. These results suggest that in HBsAg positive patients with CAH the presence or absence of HBeAg and the variation in its level can provide useful indicators of the prognosis of the disease.

A case of idiopathic hypothalamic hypothyroidism

The availability of thyrotropin hormone (TRH) has made it possible to determine whether tropic hormone deficiency is caused by pituitary or hypothalamic dysfunction. A case of hypothalamic hypothyroidism was described ina a 17 year old woman. This patient was admitted for the evaluation of hypothyroidism and secondary amenorrhea. Her T3 and T4 were decreased, with an undetectable level of base line thyrotropin. the TRH test revealed normal but delayed response of TSH. Her base line prolactin and its response to TRH were normal. Adenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and urinary 17-hydroxysteroids were also normal. ACTH response to metyrapone was normal. Evaluation of the pituitary-gonadal axis revealed a normal increase in both lutenizing hormone (LH) and follicle stimulating hormone (FSH) following the intravenous administration of lutenizing hormone releasing hormone (LHRH). These results suggest that she had hypothalamic hypothyroidism as an isolated disturbance in the hypothalamic-pituitary axis. A deficiency of TRH is probably caused by a disorder of hypothalamic function of unknown etiology since the extensive studies did not reveal any secondary causes. It is recommended that patients with amenorrhea and hypothyroidism be evaluated for possible hypothalamic hypothyroidism.

Acid-base disturbance in patients with fulminant hepatic failure

Forty-two arterial blood pH and gas determinations were carried out on 11 patients with fulminant hepatic failure. The most common type of acid-base disturbance was that of respiratory alkalosis in 22 cases (52.4%). This was partially compensated in 13 subjects (31.0%) while an accompanying metabolic alkalosis was present in 9 (21.5%). Partially compensated metabolic acidosis was observed on 15 occasions (35.7%), all of which were in patients with laboratory evidence of impaired renal failure. The mental status of the patients was evaluated in each of the categories of acid-base disturbances. Some degree of correlation was evident between the PCO2 and the magnitude of base excess and that of the severity of the encephalopathy. The lower PCO2 and greater negative base excess values tended to be nearly always present in totally comatose subjects. By contrast, there was no clear cut relationship between pH and mental state.

The depressant effect of halothane and sodium thiopental on the spontaneous and evoked activity of dorsal horn cells: lamina specificity, time course and dose dependence

The effects of halothane and sodium thiopental on dorsal horn cell unit activity were studied in the lumbar spinal cord of decerebrate, low thoracic spinal cats. Both halothane (0.5, 1 and 1.5%) and sodium thiopental (2.5, 5 and 10 mg/kg) depressed, in a dose-dependent manner, the spontaneous firing frequency of cells in Rexed laminae I, V and VI and the evoked firing frequency of cells in laminae I and V. They, however, had no effect on cells in lamina IV. The maximum depression of cell activity occurred 5 to 8 minutes after inhalation of halothane and 2 to 3 minutes after the intravenous administration of sodium thiopental. The recovery of cell activity occurred within 15 to 30 minutes after discontinuation of halothane and within 10 to 30 minutes after intravenous administration of sodium thiopental. The depressive effect of halothane and sodium thiopental, both primarily hypnotic anesthetics, on lamina VI cells is in contrast to our previous finding that morphine sulfate, nitrous oxide and ketamine hydrochloride, primarily analgesic agents, had no significant effect on this lamina.