[Effects of sevoflurane anesthesia on serotonin metabolism in rat brain]

To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on serotonin metabolism in rat brain were studied. Three percent sevoflurane was administered for twenty minutes to Wistar male rats weighing 230-270g under spontaneous respiration. The rats were sacrificed by decapitation and the brains were rapidly removed. They were dissected into nine discrete regions, locus coeruleus, pons plus medulla oblongata, hypothalamus, thalamus, basal ganglia, midbrain, hippocampus, amygdala and cerebral cortex. The contents of serotonin (5-HT) and one of its major metabolites, 5-hydroxyindole-3-acetic acid (5-HIAA) were measured by high performance liquid chromatography with the dual-cell coulometric detector before anesthesia, 20 minutes after the start of anesthesia and at the recovery from anesthesia. Significant increases in 5-HT levels were observed in the pons, hypothalamus, midbrain, amygdala and cerebral cortex by sevoflurane anesthesia as compared with the control group. 5-HIAA levels decreased significantly in the thalamus by sevoflurane anesthesia, while an appreciable increase in 5-HIAA levels was observed in the basal ganglia at the recovery from anesthesia. It is concluded that 5-HT metabolism is significantly suppressed in the pons, hypothalamus, thalamus, midbrain, amygdala and cerebral cortex during sevoflurane anesthesia and this change in 5-HT metabolism may be associated with a mechanism of sevoflurane anesthesia.

Cyclosporine stimulates hepatocyte proliferation and accelerates development of hepatocellular carcinomas in rats

A recent study from our laboratory demonstrated that cyclosporine (CsA), a prototype immunosuppressant, enhanced the growth of carcinogen-induced enzyme altered foci in rat liver, suggesting that CsA may stimulate development of hepatocellular carcinomas. In the present study, we examined (i) whether CsA accelerates development of hepatocellular carcinomas in experimental animals, (ii) whether CsA stimulates the proliferation of resting hepatocyte in vivo and (iii) whether CsA modulates the production of growth factors implicated in liver cell growth, hepatocyte growth factor (HGF), transforming growth factor alpha (TGF alpha) and transforming growth factor beta 1 (TGF beta 1). Foci of hepatocytes, positive for glutathione S-transferase placental form were induced in male F344 rats by a single dose of diethylnitrosamine followed by 7 weeks promotion by a choline-deficient diet. The animals were then divided in two groups, and subsequent development of hepatocellular carcinomas was compared in rats fed a basal diet or a basal diet containing 0.015% CsA. Development of hepatocellular carcinoma was accelerated in the rats maintained on a CsA diet. Feeding a CsA diet as the sole treatment, for 2, 4 and 10 weeks induced significant increases in liver weight, and resulted also in an enhanced incorporation by hepatocytes of 5-bromo-2-deoxy-uridine. Serum levels of glutamate-oxaloacetate transferase, glutamate-pyruvate transferase and lactic dehydrogenase were not altered by feeding a CsA diet. Northern Blot analyses of the expression of HGF, TGF alpha and TGF beta 1 mRNAs in the liver showed similar patterns of expression between rats fed a basal diet and a CsA diet. The levels of HGF mRNA were not altered in the lungs and kidneys of rats fed a CsA diet. These results indicate that CsA stimulates rat liver cell proliferation in vivo without inducing liver cell necrosis, and that this effect may contribute to accelerated development of hepatocellular carcinomas in rats fed a CsA diet. As previously observed with BR 931, a hypolipidemic peroxisome proliferator, stimulation of liver cell growth by CsA did not entail changes in the production of HGF, TGF alpha or TGF beta 1.

[A statistical analysis of sudden deafness]

The present study was carried out in order to determine factors which influenced the prognosis of sudden deafness and to try to predict the prognosis of sudden deafness, analyzed statistically by multivariate analysis. A total of 143 patients with sudden deafness diagnosed and treated at the department of otolaryngology, Ebetsu Municipal General Hospital and Obihiro Kohsei Hospital between 1986 and 1991, were selected for this study. Statistical analysis disclosed the following. 1. A good hearing level at the initial visit, a low-frequency hearing loss, the absence of vestibular symptoms and an initial visit within seven days after onset, indicate a good prognosis for sudden deafness. 2. Multivariate analysis showed that the hearing level at the initial visit most strongly influences sudden deafness, followed by the number of days from onset to initial visit, vestibular symptoms and the difference between low- and high-frequency hearing level, in that order. 3. Furthermore, multivariate analysis showed that the prognosis of sudden deafness can be predicted at a level of 78.3%, considering the above four factors. This facilitates treatment of patients with sudden deafness.

[Anesthetic experience of emergency cesarean section for a patient with myotonic dystrophy]

We report an anesthetic experience of a 28-year-old female patient complicated with myotonic dystrophy who underwent emergency Cesarean section due to threatened abortion. Anesthesia was induced with intravenous thiopental followed by topical spray of 4% lidocaine 5 ml to intubate trachea and maintained with neuroleptanesthesia with droperidol, fentanyl and nitrous oxide in oxygen. No muscle relaxant was used. The course of anesthesia and emergence from anesthesia were uneventful. However, the female infant, with Apgar score of 1 point at five minutes after delivery, died due to multiple organ failure three weeks after the delivery. Anesthetic management of a patient with myotonic dystrophy was also discussed with a literature review.

Apoptosis of lung cancer cells caused by some anti-cancer agents (MMC, CPT-11, ADM) is inhibited by bcl-2

To determine whether the apoptotic cell death induced by anti-cancer agents could be inhibited by bcl-2, we established a bcl-2-transfected human small cell lung cancer cell line, SBC-3/Bcl2. SBC-3/Bcl2 showed higher resistance to ADM, CPT-11 and MMC compared with the parental line SBC-3, with relative resistance values of 3.4, 7.6 and 5.7, respectively. However, there was no difference in sensitivity to CDDP, VP-16, ACNU, MTX and taxol between SBC-3 and SBC-3/Bcl2. Agarose gel electrophoresis showed typical DNA fragmentation of SBC-3 following treatment with CPT-11 or MMC, in a concentration-dependent manner. In contrast, the same concentration of the drugs did not induce DNA fragmentation in SBC-3/Bcl2. Treatment with CDDP resulted in the same degree of DNA fragmentation in SBC-3 and SBC-3/Bcl2. These studies indicate that bcl-2 can modulate the cytotoxicity of some anti-cancer agents by inhibiting the process of apoptosis.

[Pharmacokinetics and antitumor activity of MX2, a new morpholino anthracycline in brain tumor intracerebral transplanted in rats]

Pharmacokinetics and antitumor activity of MX2.HCl (MX2), a new morpholino anthracycline, were investigated in rats transplanted 9L gliosarcoma cells in the brain. (1) Pharmacokinetics: AUC of MX2 in the brain tumors which received intracarotid and intravenous injection of 2mg/kg of MX2 were 117.50 and 55.94 micrograms.hr/g, respectively. AUC of the brain tissue was 1.38-3.90 micrograms.hr/g. (2) Antitumor activity: The inhibition of cell growth at the concentration of 0.1 micrograms/ml was 73.1% with MTT assay. The mean survival time in tumor-bearing rats after intracarotid and intravenous injection of 2mg/kg of MX2 prolonged significantly. Therefore, it seems that MX2 will become an efficacious drug for the treatment of malignant glioma.

Chondrosarcoma of the nasal septum: surgical considerations on Le Fort I osteotomy

A case of chondrosarcoma of the nasal septum extending into the entire nasopharynx sphenoid sinus and skull base is presented. These cartilaginous tumors are rate in the head and neck, with only 28 reported in the nasal septum. They arise in tissues known to be formed of cartilage, and in the present case tumour presumably originated from the perpendicular lamina of the septum. The treatment of choice is wide surgical excision, which requires an adequate approach for gaining the widest possible exposure of tumor. Surgical considerations are discussed.

Permeability of the blood-ocular barrier in adolescent and adult diabetic patients

The permeability of the blood-ocular barrier was examined by fluorophotometry in adolescent and adult diabetic patients before the onset of retinopathy. The adolescent group consisted of 52 eyes of 52 insulin dependent diabetic patients aged 11 to 19 years and a control group of 10 eyes of 10 normal adolescents. The adult group consisted of 74 eyes of 74 non-insulin dependent diabetics and a control group of 30 eyes of 30 normal adults. The increase in lens autofluorescence in the adolescent diabetic patients compared with the controls was striking and showed a significant positive correlation (r = 0.79, p < 0.0001) with the duration of diabetes. Anterior chamber (AQ) values, an index of the permeability of the blood-aqueous barrier (BAB), increased in the adolescent diabetic patients compared with the controls and showed a significant positive correlation with glycosylated haemoglobin levels. No significant differences from the controls were observed regarding the permeability of the blood-retinal barrier (BRB). In the adult group there was no significant difference in either the permeability of the BRB or the AQ values between the diabetic and the control groups. Our results suggest that adolescent diabetic patients differ from adults in that BAB permeability is increased before the onset of retinopathy, suggesting that this is the cause of the striking increase in lens autofluorescence.

Hyperaemia prior to acute cerebral swelling in severe head injuries: the role of transcranial Doppler monitoring

Acute cerebrovascular congestion after a closed head injury is significantly related to intracranial hypertension. As an indirect method of cerebral blood flow measurement; transcranial doppler sonography (TCD) provides a rapid and noninvasive assessment of cerebral haemodynamics, including hyperaemic conditions. TCD examinations was serially performed in 35 patients with severe head injury with intact cerebral circulation; i.e. the mean flow velocity (MFV) patterns of the middle cerebral artery (MCA) did not show signs of cerebral circulatory arrest such as systolic spike, to and fro, or no flow. The results showed that the MFV of the MCAs and ipsilateral extracranial internal carotid arteries (ICAs) in 9 of these patients increased sharply and pulsatility index (PI) decreased during 48-96 hours after the injury. This was soon followed by patterns of high intracranial resistance, consistent with elevated intracranial pressure (ICP) in monitored patients and acute brain swelling on repeated computed tomographic (CT) scans. The correlation between increased MFVs, decreased PIs, and cerebral haemodynamic changes leading to acute brain swelling is discussed. The number of patients who ended with severe disability, vegetative state, or death was 66% in this group of 9 patients, compared to only 34% for the 35 patients overall with severe head injury. Though the morbidity and mortality rates largely depend on the primary injury, the presence of acute cerebral swelling aggravate the grave course in these patients. And the ability of TCD to monitor the hyperaemic state prior to oedema should lead us to adjust the therapy in order to minimize the secondary insult related to intracranial hypertension.

Evaluation of peripheral metabolic status by determination of Na-K ATPase pump activity in circulating erythrocytes in patients with thyroid diseases and nonthyroidal illnesses

The number of Na-K ATPase units in erythrocytes (RBC) was determined by the maximal ouabain binding assay in 25 normal subjects and patients with hyperthyroidism (n = 29), hypothyroidism (8), chronic renal failure (CRF, 19) and with neoplastic disorders (NP, 12). The activity of the pump units was also assessed by measuring ouabain-sensitive 86Rb uptake in some of these subjects. In addition, it was determined in mononuclear cells in normal controls and patients with hyper- and hypothyroidism and CRF. Significant diminution of the number of the RBC pump units was found in hyperthyroidism, while it was increased in hypothyroidism. The binding (O) of old RBC was significantly lower than that (Y) of young RBC and a striking correlation was observed between the % reduction rate ((Y-O)/Y) of the binding and the serum T4 level in hyperthyroidism (r = 0.85, P < 0.02). No difference was observed in pump units of mononuclear cells in normal and hyper- and hypothyroidism. It is suggested that the thyroid hormone- mediated disappearance of the pump units in RBC may play a role in reducing the number of pump units in RBC in hyperthyroidism. The ratio of RBC 86Rb uptake to the number of the pump units in the same cell (U/B) bore a significant relation to serum T3 (r = 0.48, P < 0.05) and T4 (r = 0.49, P < 0.05) indicating that the U/B is a useful index for the peripheral metabolic status. In CRF patients with low T3 levels, bindings were increased but those in NP with low T3 was almost normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Two-year follow up on the protective value of dust masks against farmer's lung disease

Some advocate moving away from the farm environment for farmers affected with farmer's lung disease (FLD), but most affected farmers still live on farms. In this study, we evaluated the practicality of dust masks and their effectiveness in prevention of FLD. The dust masks we chose were practically used and no new severe episodes of FLD developed in 20 of 21 farmers with FLD using the masks during a 2-year period. When the farmers took off the dust masks in a farming environmental provocation test, statistically significant reductions in FVC (mean 3.43 to 3.351, p < 0.01), DLco (mean 19.6 to 18.2 ml/torr/min, p < 0.01), and DL/VA (mean 5.1 to 4.8 (x10(-3)) 1/torr/min, p < 0.01) were observed several hours after exposure. These findings suggest that the dust masks were used practically during routine dairy farming and were effective in protection against FLD.

Measurement of erythrocyte Na,K-ATPase activity in normal pregnant women

To investigate the peripheral metabolic status during normal pregnancy, we measured the number of erythrocyte Na,K-ATPase units as well as the cation transport activity of the pump from 32 normal pregnant women and 12 normal controls. The number of pump units determined by maximal ouabain binding to erythrocyte in normal pregnancy was significantly higher than that in normal controls (mean +/- SEM: 0.52 +/- 0.03 vs. 0.39 +/- 0.04 pmol/10(9)RBC, P < 0.05). The total cation transport activity of the pump measured by 86Rb uptake also significantly increased during pregnancy (98.9 +/- 6.4 vs. 73.1 +/- 5.4 nmol/10(9) RBC, P < 0.01). However, the mean cation transport activity per pump unit, which was presumed to be an indicator of the peripheral metabolic status, was unchanged in any of three trimesters when compared with that in normal controls. Serum FT4 levels measured by two different methods were significantly lower in the third trimester than in the first trimester (P < 0.01). In conclusion, erythrocyte Na, K-ATPase activity per pump unit is normal in pregnant women, suggesting that the peripheral metabolic status in pregnancy seems to be normal. Increases in both the number and function of the pump may be influenced by factors other than thyroid function.

Analysis and distribution of etoposide in rat brain tumor model: intracarotid versus intracarotid with angiotensin II-induced hypertension

The brain tissue distribution of etoposide has been investigated in 9L gliosarcoma-bearing rats with or without hypertension induced by angiotensin II (AT II). The rat brain tumor models were divided into the following two groups according to etoposide administration route: intracarotid injection (IC) group and intracarotid injection with hypertension induced by AT II (IHIC) group. Ten mg/kg of etoposide was given, and 30 min and 2, 4, 8, and 24 hr later the rats were sacrificed. The drug concentrations in the serum, tumor, and normal brain tissue were analyzed by high-pressure liquid chromatography. The etoposide concentration in the serum, tumor, and normal brain tissue peaked at 30 min in both groups. The serum concentration was similar between the two groups. The etoposide concentration in the tumor was at least 2.2 times higher in the IHIC group than in the IC group at 30 min and 2 hr. The area under drug concentration curve (AUC) in the tumor in the IHIC group was about 2.2 times higher than that in the IC group. The etoposide concentration in the normal brain on the drug injection side changed only slightly from 0.5 hr to 4 hr and was about 3 times higher in the IHIC group than in the IC group. The etoposide concentration in the contralateral normal brain was very low in both groups at 30 min and disappeared thereafter. Intracarotid injection of anticancer drugs with AT II-induced hypertension further increases the drug concentration and AUC in the tumor compared with intracarotid injection alone and can be useful in treatment of malignant brain tumors.

Spontaneous histiocytic sarcoma with possible origin from the bone marrow and lymph node in Donryu and F-344 rats

Ninety-five male and 96 female Donryu rats reared up to 120 wk of age and 244 male and 243 female F-344 rats used as untreated controls in 5 carcinogenicity studies were examined histopathologically to clarify the primary site of histiocytic sarcoma. Histiocytic sarcoma in Donryu rats was observed in 5 of 95 (5.3%) males and 4 of 96 (4.2%) females. In F-344 rats, 4 of 244 (1.6%) males and 3 of 243 (1.2%) females had the neoplasms. Histologically, sarcomas consisting of large pleomorphic histiocytic cells were seen in the bone marrow, liver, lymph node, spleen, and lung. Among 16 sarcomas observed, 15 had neoplastic lesions in the bone marrow, and 1 F-344 rat had the lesions only in the lymph nodes. Eleven (6 F-344 rats and 5 Donryu rats) of the 15 cases had the lesions in the liver, and 4 Donryu rats had no lesions in the liver but lesions in the lymph node and/or spleen, except for 1 case where the sarcoma occurred only in the bone marrow. Among the 11 cases with the lesions both in the liver and bone marrow, neoplastic lesions were found also in the lymph node, spleen, and/or lung, but the severity of neoplastic proliferation of these organs was not so marked as that in the bone marrow except for 2 cases. Although histiocytic sarcomas in rats are considered to originate from the liver, peritoneum, or subcutis, the present results strongly suggest that some histiocytic sarcomas in Donryu and F-344 rats may also originate from the bone marrow and lymph nodes.

[T-cell subsets and intercellular adhesion molecule-1 in human allergic nasal mucosa]

We performed an immunohistological study of T-cell subsets and intercellular adhesion molecules in allergic and non-allergic nasal mucosa. In allergic mucosa, the number of CD4 positive cells tended to dominate that of CD8 positive cells. CD8 positive cells were detected randomly in all regions of the mucosa, whereas CD4 positive cells tended to be clustered in the superficial portion of the lamina propria. Furthermore, the number of CD4 positive cells correlated with the intensity of ICAM-1 expression, especially in the superficial portion of the lamina propria.

[Effects of sevoflurane anesthesia on dopamine metabolism in the rat brain]

To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on dopamine metabolism in rat brain were studied. Sevoflurane 3% was administered for 20 minutes to Wistar male rats weighing 230-270 g under spontaneous respiration. The rats were sacrificed by decapitation and the brains were rapidly removed. They were dissected into nine discrete regions, locus coeruleus, pons plus, medulla oblongata, hypothalamus, thalamus, basal ganglia, midbrain, hippocampus, amygdala and cerebral cortex. The contents of dopamine (DA) and its major metabolites, 3, 4-dihydroxyphenyl acetic acid (DOPAC) and homovanillic acid (HVA) were measured by high performance liquid chromatography with the dual-cell coulometric detector before anesthesia, 20 minutes after the start of anesthesia and at the recovery from anesthesia. Significant increases in DA levels were observed in the pons, hypothalamus, thalamus and amygdala by sevoflurane anesthesia as compared with the control group. DOPAC levels increased significantly in the pons, hypothalamus, basal ganglia and cerebral cortex at the recovery from anesthesia. A significant increase in HVA levels was observed in amygdala by sevoflurane anesthesia, while an appreciable decrease in HVA levels was observed in hippocampus at recovery from anesthesia. It is concluded that DA metabolism is significantly suppressed in the pons, hypothalamus, thalamus, basal ganglia, midbrain and amygdala during sevoflurane anesthesia and this change in DA metabolism may be associated with the mechanism of sevoflurane anesthesia.

[Analysis of optic nerve head circulation in diabetics using a laser Doppler technique]

The authors measured the red blood cell speed distributions in the capillaries of the optic nerve head using a laser Doppler technique. We calculated the widths of Doppler-broadened frequency spectra of laser light scattered from temporal sites on the optic nerve head in 34 Type I diabetic patients (mean age, 29.5 years; 12 patients having no retinopathy; 22 having background retinopathy) and in 29 age- and sex-matched normal controls. Doppler broadening proportional to the red blood speed was 763 +/- 113 Hz (mean +/- SD) in the diabetics and 912 +/- 167 Hz in the controls. The difference was statistically significant. Mean blood pressure and intraocular pressure in the diabetics were not significantly different compared to controls. Our finding of abnormally low capillary blood speeds suggests that pathologic alterations occur in the microvasculature of the optic nerve head in the early stages of diabetic retinopathy.

Ocular circulatory changes following scleral buckling procedures

The effect of segmental scleral buckling (SB) on ocular circulation was evaluated by measurements of the ocular pulse amplitude (PA) and the ophthalmic artery pressure (OAP). In this study the OAP was defined as the intraocular pressure (IOP) at which the PA disappeared during increasing IOP. Twenty four patients with unilateral rhegmatogenous retinal detachment who underwent SB of varying extent were studied; the unoperated fellow eyes served as controls. Both the OAP and the ophthalmic perfusion pressures (OAP minus IOP) decreased significantly (p < 0.01) as the area of SB treatment increased. Follow-up measurements showed that the OAP was relatively lower up to 3 months postoperatively than after 3 months, and then remained stable. Our results indicated that SB affects the ocular pulse measurements and may decrease ocular blood flow because of decreased ophthalmic perfusion pressure, probably due to increased choroidal vascular resistance, and that the greater the extent of the SB treatment, the greater the possibility of decreased ocular blood flow.

Intracranial germ-cell tumor with synchronous lesions in the pineal and suprasellar regions: report of six cases and review of the literature

The features of intracranial germ-cell tumor with synchronous lesions in the pineal and suprasellar regions (GCTSPS) in six patients were investigated. GCTSPS accounted for 12.8% of all germ-cell tumors (GCT) in our brain tumor study group. In all cases, the initial symptoms were attributable to the suprasellar lesion, and symptoms due to the pineal GCT developed only after admission. Five of the six cases were histologically diagnosed as germinoma. In all cases, tumors of both regions disappeared after irradiation, resulting in no recurrence for an average of 55.3 months. Our experience and reports in the literature suggest that GCTSPS is highly sensitive to radiation in most cases, although some reports indicated that recurrence is frequent after radiation therapy alone. It is suggested that histological diagnosis in one of the GCTSPS lesions is undertaken to make a plan for the following treatment.

Long-term use of low molecular weight heparin ameliorates hyperlipidemia in patients on hemodialysis

Hyperlipidemia is one of the major risk factors for cardiovascular death in long-term hemodialysis (HD) patients. To clarify whether unfractionated heparin (UFH) contributes to the pathogenesis of hyperlipidemia, nine Type IIb, seven Type IV, and 10 normolipidemic patients, who had been dialyzed with 80.7 IU/Kg heparin, were dialyzed with 40 anti-Xa U/kg of low molecular weight heparin (LMWH) (Logiparin, Novo-Nordisk, Gentfe, Denmark) for 6 months. Seven normolipidemic patients were also dialyzed with heparin as controls. Decreases in triglyceride (TG) during HD with LMWH were significantly less than those with heparin. However, lipoprotein lipase activities (LPL) during HD with LMWH and heparin, and those before and after 6 months on LMWH, were no different. During the 6 months on LMWH, serum total cholesterol, TG, and alpha lipoprotein significantly decreased in Type IIb patients but did not change in Type IV. In contrast, beta lipoprotein slightly increased in Types IIb, IV, and normolipidemic patients who were dialyzed with LMWH but was unchanged in the controls. These observations suggest that UFH aggravates hyperlipidemia in patients, but these effects cannot be attributed to depletion of endothelial LPL liberated by UFH.