Detrusor underactivity causes neurogenic voiding dysfunction in a rat bilateral accessory nerve-injury model

We aimed to investigate detrusor function in a previously developed rat neurogenic voiding dysfunction model that we have developed previously. We performed sham or bilateral accessory nerve injury (BACNI) surgeries on ten-week-old male Wistar/ST rats. One week after surgery, we evaluated detrusor contractility in the bladder using isometric tension and mRNA expression assays. Cholinergic contraction was attenuated in the injury model, whereas carbachol-evoked contraction was enhanced, and mRNA expression of the cholinergic receptor increased. These findings suggest that there was a reduction in neurotransmitter release causing detrusor underactivity.

Effects of High Salt Intake on Detrusor Muscle Contraction in Dahl Salt-Sensitive Rats

High salt intake has been reported as a risk factor for urinary storage symptoms. However, the association between high salt intake and detrusor muscle contraction is not clear. Therefore, we investigated the effects of high salt intake on the components of detrusor muscle contraction in rats. Six-week-old male Dahl salt-resistant (DR; n = 5) and Dahl salt-sensitive (DS; n = 5) rats were fed a high salt (8% NaCl) diet for one week. The contractile responses of the detrusor muscle to the cumulative administration of carbachol and electrical field stimulation (EFS) with and without suramin and atropine were evaluated via isometric tension study. The concentration-response curves of carbachol were shifted more to the left in the DS group than those in the DR group. Contractile responses to EFS were more enhanced in the DS group than those in the DR group (p < 0.05). Cholinergic component-induced responses were more enhanced in the DS group than those in the DR group (p < 0.05). High salt intake might cause urinary storage symptoms via abnormalities in detrusor muscle contraction and the enhancement of cholinergic signals. Excessive salt intake should be avoided to preserve bladder function.

Impairment of accessory nerves around major pelvic ganglion leading to overflow urinary incontinence in rats

AIMS

To investigate the relationship between lower urinary tract function and the accessory nerve (ACN) arising from the major pelvic ganglion (MPG).

METHODS

Ten-week-old male Wistar/ST rats were randomly divided into eight groups according to the type of treatment (sham or bilateral accessory nerve injury [BACNI]) and the duration of observation (3 days, 1 week, 2 weeks, or 4 weeks: Sham-3d, Sham-1w, Sham-2w, Sham-4w, BACNI-3d, BACNI-1w, BACNI-2ws, and BACNI-4w. BACNI was induced in the following manner: the ACN was crushed for 1 min (2 mm away from the MPG) using reverse-action tweezers. The same procedure was performed on both sides. On the last day of each observation period, the bladder function was measured by awake cystometry, and histological evaluation was performed.

RESULTS

All rats in the Sham groups micturated normally. In the BACNI-3d and BACNI-1w groups, all rats showed symptoms of overflow urinary incontinence (OUI). This OUI improved gradually over time. The bladder's size in the BACNI group was significantly larger than that in the Sham group (p < .01). In addition, fibrosis was observed in the subserosa of the bladder of rats in BACNI groups.

CONCLUSION

The BACNI model rats exhibited OUI, suggesting that ACN is involved in the lower urinary tract function. It might be possible that ACN controls the function of either the bladder, the urethra, or both.

Sustained effects of intralymphatic pollen-specific immunotherapy on Japanese cedar pollinosis

BACKGROUND

Intralymphatic immunotherapy (ILIT) for allergic patients requires only a few intralymphatic injections of the allergen. However, the effectiveness and safety for Japanese cedar pollinosis are unclear. The objectives of this study were to clarify whether and how long ILIT is effective for pollinosis, and its safety.

METHODS

In an open pilot investigation followed by a double-blind, placebo-controlled study, patients with Japanese cedar pollinosis received 3 intralymphatic inguinal injections of the pollen extracts before the first pollen season. The symptom medication score (SMS), nasal provocation testing and scoring visual analogue scale (VAS) were assessed after the first-third seasons.

RESULTS

(1) Although mild adverse events were induced at the injected site, severe adverse events were not noted. (2) During the latter part of the first season, ILIT-treated patients (n=12) tended to show improved SMS compared to placebo-treated (n=6) without statistical significance. When assessed by nasal provocation testing and VAS scoring after the first season, the effectiveness of ILIT was significant. (3) The effects of ILIT continued until the second or third season. (4) Neither allergen-specific antibodies nor Treg/Breg cells changed in the peripheral blood.

CONCLUSIONS

ILIT was safe and effective for Japanese cedar pollinosis. The clinical effects remained for 1-2 years.

Anagliptin, a dipeptidyl peptidase-4 inhibitor, improved bladder function and hemodynamics in rats with bilateral internal iliac artery ligation

AIMS

To investigate the effect of anagliptin (Ana), a dipeptidyl peptidase-4 (DPP-4) inhibitor, on acute ischemia-induced bladder dysfunction in rats.

METHODS

Eight-week-old female Wistar-ST rats were randomly assigned into four groups: (a) sham; (b) ligation (Lig); (c) Lig + Ana; and (d) Lig + Liraglutide (a glucagon-like peptide-1 [GLP-1] receptor agonist; Lira). Rats in the Lig, Lig + Ana, and Lig + Lira groups underwent ligature of the bilateral internal iliac arteries. Ana was orally administered mixed with the CE-2 diet. Lira was subcutaneously administered once a day. Blood glucose levels, plasma dipeptidyl peptidase 4 (DPP-4) activity, GLP-1 levels, and bladder function were measured in all groups. Bladder blood flow was measured in the sham, Lig, and Lig + Ana groups, 4 weeks postsurgery.

RESULTS

No differences in blood glucose levels among the groups were observed. DPP-4 activity decreased in the Lig + Ana group (P < .01). GLP-1 levels in the Lig + Ana and Lig + Lira groups were higher than those in the sham and Lig groups (P < .01). Intercontraction intervals (ICIs) were longer in the Lig and Lig + Lira groups than in the sham group (P < .05), but similar to those observed in the Lig + Ana and sham groups. The Lig group exhibited reduced bladder blood flow relative to the sham group (P < .01); however, this measure improved in the Lig + Ana group (P < .01).

CONCLUSIONS

Ana administration improved ICIs and bladder blood flow after acute bladder ischemia through a GLP-1 receptor-independent signaling pathway, without altering the blood glucose levels. Therefore, Ana dosing might be useful to prevent ischemia-induced bladder dysfunctions.

Novel scoring system and algorithm for classifying chronic rhinosinusitis: the JESREC Study

Background

Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS.

Methods

This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS.

Results

We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti‐inflammatory drugs intolerance were associated significantly with recurrence.

Conclusion

We subdivided CRSwNP in non‐ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.

166 COMPARISON OF TWO METHODS TO SYNCHRONIZE CROSSBRED BEEF HEIFERS FOR EMBRYO TRANSFER

Estrous synchronization with prostaglandin in commercial MOET programs frequently results in insufficient numbers of recipients for embryo transfer. The aim of this trial was to compare the efficiency of 2 different methods of estrous synchronization in crossbred beef heifers. A total of 235 cycling heifers (Brangus and Braford), with a mean age of 24 months (range 22-26 months), body condition score of 3.5 ± 0.1 (1-5 scale), and mean weight of 340 ± 22 kg were assigned to 2 treatment groups stratified according to body weight and genotype. In Group 1 (n = 157), heifers received 2 injections of prostaglandin [Croniben, 150 μg of D(+) cloprostenol, i.m.; Biogenesis-Bágo, Buenos Aires, Argentina] with an interval of 14 days. After the second injection, detection of estrus was monitored for 5 days. In Group 2 (n = 78), heifers received an intravaginal device of progesterone (Day 0; 0.558 g; Cronipres Mono Dose M-24, Biogenesis-Bágo) and at the same time received an i.m. injection of estradiol benzoate (2 mg; Cronibest, Biogenesis-Bágo). On Day 7, devices were removed and heifers were injected with prostaglandin. Twenty-four hours later (Day 8), 1 mg of estradiol benzoate was injected i.m. All recipients had estrus detected for 72 h after the end of treatment to determine the estrous synchronization rate. Before embryo transfer 7 days after the detected estrus, heifers were examined by transrectal ultrasonography (Chison 600Vet, 5-MHz transducer, National Ultrasound, Duluth, GA, USA) to confirm the presence of a CL and its size or an unovulated follicle on the ovaries. Those with a CL of 1.7 cm2 or greater were selected to receive a frozen-thawed embryo. The frequencies of synchronous estrus, ovulation, unovulated follicles, and use of recipients were compared by chi-square test. Group 2 had a higher estrous synchronization rate (70%) and proportion of selected recipients (51.2%) compared with Group 1 (55% and 35.6%, respectively; P < 0.05). Ovulation rate (64% v. 72%) and incidence of unovulated follicles (20.6% v. 21.8%) for Groups 1 and 2, respectively, did not differ (P > 0.05). In summary, treatment with a 0.558-g progesterone intravaginal device, plus injections of estradiol benzoate and PGF, was more efficient than 2 PGF injections alone in synchronizing estrus and increased the use of crossbred beef heifer recipients in MOET programs. The ovulation rate and incidence of unovulated follicles were similar in both methods of estrous synchronization.

Moderate hypothermia, but not calpain inhibitor 2, attenuates the proteolysis of microtubule-associated protein 2 in the hippocampus following traumatic brain injury in rats

BACKGROUND AND OBJECTIVE

The degradation of the cytoskeletal protein microtubule-associated protein 2 (MAP2), by calpain has been known to occur following traumatic brain injury. We examined the therapeutic potential of calpain inhibitor 2, compared with that of moderate hypothermia in traumatic brain injury produced by weight drop in rats.

METHODS

An inhibitor treated group (n = 8) received calpain inhibitor 2 intravenously (i.v.) for 5 min before and for 6 h after injury (total 2 micromol); a hypothermic (HT) group (n = 8) was maintained at 30 degrees C (temporalis muscle temperature) for 45 min prior to and 60 min after injury; an untreated (UT) group (n = 8) received an infusion of inactive vehicle. Eight rats (sham group) underwent surgery without brain injury. Histopathological (haematoxylin and eosin staining) and MAP2 (immunohistchemistry and western blotting) evaluations were performed at 6 h after injury.

RESULTS

Ipsilateral cortical damage was marked in the injured groups. In the hippocampus, marked pyramidal neuronal damage was observed in the UT and calpain inhibitor treated (CI) groups, while these neurons were better preserved in the HT group. The hippocampal MAP2 levels in the UT, CI and HT groups were significantly decreased to 13 +/- 9%, 28 +/- 33% and 62 +/- 25% of the sham contol, respectively. MAP2 concentration in the HT group was significantly higher than in UT and CI groups (P < 0.05).

CONCLUSION

The results suggest that moderate hypothermia, but not calpain inhibitor 2 with the tested regime, attenuates cytoskeletal damage in the ipsilateral hippocampus at 6 h after traumatic brain injury.

Changes in cerebral blood flow velocity elicited by surgical stimulation are dependent on the PaCO(2) level

PURPOSE

To investigate the influence of PaCO(2) manipulation on the cerebral hemodynamic response to surgical stimulation.

METHODS

Twenty-one female patients undergoing elective gynecological surgery performed through a lower median abdominal incision were enrolled. After obtaining steady general anesthesia with 1.7% sevoflurane and 60% nitrous oxide, the patients were randomly assigned to three groups, hypocapnia (PaCO(2)=30 mmHg), normocapnia (PaCO(2)=38 mmHg), and hypercapnia (PaCO(2)=44 mmHg) groups. The changes in mean blood flow velocity in the middle cerebral artery (Vmca) were evaluated using transcranial Doppler ultrasonography during nine minutes after surgical incision.

RESULTS

The change in Vmca (Delta Vmca) with surgical incision during hypercapnia (30-36 cm*sec(-1)) was significantly greater than during normocapnia (20-22 cm*sec(-1)) and hypocapnia (13-15 cm*sec(-1)). The Delta Vmca in the hypocapnia group was significantly smaller than in the normocapnia group. Arterial blood pressure increased with incision but there was no significant difference among the three groups.

CONCLUSION

Cerebral hemodynamic changes evoked by surgical stimulation are attenuated by hypocapnia and are augmented by hypercapnia, even within a clinically relevant range of PaCO(2).

Enhanced production and activation of progelatinase A mediated by membrane-type 1 matrix metalloproteinase in human oral squamous cell carcinomas: implications for lymph node metastasis

We measured the production levels of seven different matrix metalloproteinases (MMP-1, 2, 3, 7, 8, 9 and 13) and two tissue inhibitors of metalloproteinases (TIMP-1 and 2) in the homogenates of human oral squamous cell carcinomas and control normal squamous epithelia by the corresponding sandwich enzyme immunoassay systems. The levels of MMP-1, 2, 3, 8, 9, 13 and TIMP-1 were significantly higher in the carcinoma samples than in the control. Among them, only the production level of MMP-2 was significantly higher in the carcinomas with cervical lymph node metastasis than in those without metastasis (P < 0.05). Gelatin zymography demonstrated that activation ratio of the zymogen of MMP-2 (proMMP-2) is significantly higher in the carcinomas with lymph node metastasis than in those without metastasis (P < 0.05) or normal control (P < 0.01). Quantitative RT-PCR for membrane-types 1, 2 and 3 MMPs (MT1, 2 and 3-MMPs), which activate proMMP-2 in vitro, demonstrated that MT1-MMP is predominantly expressed in the carcinoma tissues, and the expression level is significantly higher in the carcinomas with lymph node metastasis than in those without metastasis (P < 0.05) or the control samples (P < 0.05). Although MT2-MMP and MT3-MMP were detected in approximately 30% of the carcinoma cases, their expression levels were extremely lower compared with that of MT1-MMP. There was a direct correlation between the MT1-MMP expression level and proMMP-2 activation ratio (r = 0.62, P < 0.01). In situ hybridization and immunohistochemistry indicated that carcinoma cells and stromal cells adjacent to carcinoma cell nests express MT1-MMP transcripts and protein. MMP-2 and TIMP-2 were also immunolocalized to the carcinoma cells in the carcinoma samples. By in situ zymography, gelatinolytic activity was demonstrated in the carcinoma cell nests and abolished by the treatment with an MMP inhibitor, BB94. These results suggest that among seven different MMPs, the production of proMMP-2 and its activation mediated by MT1-MMP play an important role in the cervical lymph node metastasis of the human oral squamous cell carcinomas.

[Perioperative management of endovascular stent graft placement for abdominal aortic aneurysm]

We retrospectively examined the changes in hemodynamics, oxygen index and renal function along with the complications in 25 patients who had undergone endovascular stent graft placement (ESG) surgery for abdominal aortic aneurysm. During stent graft placement, mean arterial pressure decreased to 58 +/- 8 mmHg by increasing the dose of anesthetics and/or using vasodilators. Except for this intended hypotensive period, mean arterial pressure and heart rate were relatively stable and adequately maintained during surgical manipulation. Oxygenation index was well maintained. A patient with a high preoperative creatinine level underwent prophylactic hemodialysis postoperatively. In other patients except one who died in early postoperative period, both BUN and creatinine levels were kept within normal ranges. Four patients died postoperatively and the causes of the death in two patients are related to the surgical procedure; one with multiple emboli possibly due to released atheloma from the aortic wall during procedure, the other with sepsis due to infected stent graft. Although ESG is a well tolerated procedure, embolism is the most serious complication. Careful preoperative evaluation of the ascending arch and descending aortic wall and monitoring with transcranial doppler are necessary.

[Private practitioner & clinical laboratory physicians]

The clinical(laboratory) examiner should know how to accommodate clinical necessity. Instead of the real necessity(patient's needs), the clinical examination is dependent on the physician's own clinical skill. That is clinical laboratory examinations are ordered by the doctor's own clinical experiments and data is judged and analyzed by the mass standardized levels. Each patient's own bias must be ignored. From the medical practitioner's viewpoint(who is running his own clinic), it is desirable to have personal laboratory levels to have person-to-person and tailor-made medical management. Above all, for the futuristic medical examiner, we suggest urgent development of several parameters which will easily describe personal basic laboratory levels. (We applied for the patient of "Vessel Age" as for the new personal basic laboratory level to show atherosclerotic degeneration.)

[Value of upper gastrointestinal endoscopic examination of head and neck cancer patients]

Between January 1995 and March 1999, we performed the upper gastrointestinal endoscopic examinations on 287 patients with head and neck cancers and detected 23 cases (8%) of esophageal cancer and 8 cases (2.8%) of gastric cancer, showing how frequently esophageal cancer occurs in head and neck cancer. The esophageal cancer involved the oral cavity in 8 cases (9.5%), the oropharynx in 3 cases (8.6%), the hypopharynx in 10 cases (19.6%), and the larynx in 2 cases (2%). Esophageal cancer occurred most frequently in hypopharyngeal cancer, particularly the pyriform sinus type and the postcricoid type. We conclude that upper gastrointestinal endoscopic examination, including Lugol staining, is necessary in head and neck cancer patients.

[Study of matrix metalloproteinase-2 and -9 in thyroid papillary cancer]

Metastasis of cancer starts with the penetration of cancer cells through the membrane surrounding the cancer focus into the stroma (extracellular matrix). The focal membrane consists of mainly type-IV collagen. An immunochemical study of 28 patients with benign thyroid nodular diseases and 27 patients with papillary carcinoma revealed the fragmentation of type-IV collagen in 4 patients with papillary carcinoma. Matrix metalloprotease (MMP)-2 and MMP-9 are the major enzymes which decompose type-IV collagen, and they have been suggested to be related to cancer metastasis. Therefore, we conducted biochemical and immunohistochemical studies to determine the relationship between these MMPs and the degree of malignancy in thyroid diseases. The concentration of MMP-2 in the serum of patients with papillary carcinoma and patients with benign nodules was 526.0 +/- 96.6 and 522.7 +/- 114.6 ng/ml, respectively, and that of MMP-9 was 53.8 +/- 40.3 and 39.9 +/- 36.0 respectively. There was no significant difference between the two groups in the concentration of either enzyme. The concentration of TIMP-2 in the serum was below the detectable level. On the other hand, the concentration of MMP-2 in the tissue of papillary carcinoma, benign nodules and normal tissue was 12.1 +/- 8.1, 5.7 +/- 4.3, and 0.6 +/- 0.5 ng/mg tissue protein, respectively, and that of MMP-9 was 4.2 +/- 4.1, 2.1 +/- 1.7, and 0.4 +/- 0.3 ng/mg tissue protein, respectively. Concentrations of both enzymes were significantly higher in the papillary carcinoma tissue. Immunohistochemical studies revealed a diffuse granular distribution of MMP-2 in the cytoplasm of the tumor cells. These findings imply that MMP-2 and MMP-9 are related to the degree of malignancy of cancer, especially metastasis.

Cerebrovascular CO2 reactivity during anesthesia in patients with diabetes mellitus and peripheral vascular disease

BACKGROUND

Diabetes mellitus (DM) and systemic atherosclerosis are risk factors for stroke. Although the origins of increased risk are complex, one possibility is that cerebrovascular reactivity is impaired and does not allow the brain to compensate for aberrations in physiology. The current study tested this issue by evaluating mean blood flow velocity of the middle cerebral artery (Vmca) and carbon dioxide reactivity during anesthesia in patients with DM and peripheral vascular disease (PVD).

METHODS

Fifty-two patients were observed: 20 patients with DM (the DM group), 12 patients with PVD (the PVD group), and 20 patients classified as American Society of Anesthesiologists physical status 1 or 2 (the control group). The Vmca was measured using transcranial Doppler ultrasonography during isoflurane-nitrous oxide anesthesia. After measuring baseline Vmca at a partial pressure of carbon dioxide in arterial blood (PaCO2) of 37.7 +/- 4.5 mmHg (mean +/- SD), measurements were repeated at a PaCO of 44.2 +/- 3.8 mmHg, and the carbon dioxide reactivity (absolute value: cm x s(-1) x mmHg(-1); relative value: percentage of baseline Vmca/mmHg) was calculated.

RESULTS

The baseline Vmca of the DM group (51 +/- 12 cm/s) was significantly greater than those of the control group (42 +/- 6 cm/s) and the PVD group (42 +/- 13 cm/s). The absolute and relative values of carbon dioxide reactivity in the DM group (3.1 +/- 1.3 cm x s(-1) x mmHg(-1); 6.3 +/- 2.4%/mmHg) were significantly greater than or equivalent to those of the control group (2.3 +/- 0.8 cm x s(-1) x mmHg(-1); 5.3 +/- 1.7%/mmHg), respectively. In the PVD group, the baseline Vmca was equivalent to the control group, but the carbon dioxide reactivity (1.1 +/- 0.5 cm x s(-1) x mmHg(-1) 2.8 +/- 1.2%/mmHg) was significantly less.

CONCLUSIONS

The patients with DM have increased baseline cerebral blood flow velocity and normal carbon dioxide reactivity during anesthesia. The patients with PVD have decreased carbon dioxide reactivity, but baseline flow velocity is maintained.

[Matrix metalloproteinase-2 concentrations in squamous cell carcinoma of the head and neck and its clinical significance]

Tumor cells degrade extracellular matrix components (ECM) to invade surrounding tissues. Cancer cells are known to produce various ECM-degrading enzymes including matrix metalloproteinases (MMPs), serine proteinases and cathepsins. Type IV collagen is one of the major components of the basement membrane, and it composes the structural scaffold of these specialized sheets of the ECM. The enzymatic degradation of type IV collagen is initiated by MMPs, in particular MMP-2 (a 72 kDa type IV collagenase) and MMP-9 (a 92 kDa type IV collagenase) which play a key role in cancer invasion and metastasis. In this study, we investigated MMP-2 concentrations and the activity of type IV collagenase in cancer tissue homogenate in 21 cases with head and neck carcinomas and 6 cases with normal mucosa. MMP-2 concentrations did not differ between normal mucosa and tumor tissue without lymphnode metastases. Type IV collagenase activity in normal mucosa was below the detection limit. MMP-2 concentrations had no relation to tumor size, however MMP-2 concentrations in tumor tissue with lymphnode metastases were higher than that in cases without lymphnode metastasis (35.8 +/- 20.5, 20.0 +/- 9.7 ng/mg protein, respectively). However, there was no correlation between MMP-2 concentrations and type IV activity in tumor tissues. These results suggest that MMP-2 plays an important role in tumor invasion and metastasis, so MMP-2 could be a useful biological tumor marker for metastasis and prognosis.

[Assessment of ventriculoarterial coupling in humans by transesophageal echocardiography and radial artery pressure tracing]

To investigate coupling between the heart and arterial system in patients undergoing elective non-cardiac surgery, we determined both the ventricular elastance and the effective arterial elastance in two groups of subjects: normal group, 68 subjects without heart disease; and cardiac group, 33 subjects with heart disease. Left ventricular end-systolic (Ves) and end-diastolic (Ved) volumes were determined by transesophageal echocardiography. By assuming that left ventricular end-systolic pressure (Pes) is close to mean arterial blood pressure (MAP) and that x-axis intercept (Vo) is zero, the ventricular elastance (E'max) was approximated as MAP/Ves, and the effective arterial elastance (Ea) as MAP/(Ved-Ves). In 222 (74%) of the 299 measurements obtained in normal group, Ea/E'max was nearly 0.5, which is a condition for a maximal mechanical efficiency, while in 61 measurements (20%) Ea was almost equal to E'max (Ea/E'max = 1), which is a condition for maximal stroke work from a given end-diastolic volume. In contrast, in cardiac group, Ea/E'max was nearly 0.5 in 56 (41%) of the 137 measurements, while in 42 measurements (31%) Ea/E'max was nearly 1. In addition, although the value of Ea/E'max over 2, which represents severe heart failure, was not observed in normal group, Ea/E'max was over 2 in 10 measurements (7%) in cardiac group. Thus, the present results suggest that, as reported previously in awake patients, ventriculoarterial coupling is set toward higher left ventricular work efficiency in surgical patients without heart disease, whereas in patients with heart disease, ventricular and arterial properties are so matched as to maximize stroke work at the expense of the work efficiency.

Prostaglandin synthase 1 and prostaglandin synthase 2 both participate in activation-induced prostaglandin D2 production in mast cells

Activation of MMC-34 cells, a murine mast cell line, or bone marrow-derived mast cells by aggregation of IgE cell surface receptors or addition of calcium ionophore stimulates prostaglandin (PG) D2 synthesis and secretion. An initial rapid burst of PGD2 synthesis, complete within 30 min, is followed by a slower subsequent production of PGD2 that reaches a maximum 4 to 8 h after activation in MMC-34 cells. PG synthase 1 (PGS-1) message and protein are expressed constitutively in MMC-34 cells and are not modulated by exposure to calcium ionophore or aggregation of IgE receptors. In contrast, activation of MMC-34 or bone marrow-derived mast cells induces expression of the PG synthase 2 (PGS-2) gene. PGS-2 induction following mast cell activation is blocked by dexamethasone. The initial PGD2 burst in activated MMC-34 cells is prevented by aspirin pretreatment, suggesting that constitutive PGS-1 present in mast cells before activation is responsible for the early PGD2 production in response to activation. In contrast, the later phase of PGD2 production is blocked by dexamethasone, cycloheximide, or NS-398, a PGS-2-specific nonsteroidal anti-inflammatory drug that inhibits PGS-2 enzyme activity but not PGS-1 activity. These data demonstrate that mast cell activation results 1) in the induction of PGS-2 gene expression, and 2) in both PGS-1-dependent PGD2 synthesis and PGD2 synthesis that is dependent on the activation-induced synthesis and activity of PGS-2.

Prostaglandin synthase 1 and prostaglandin synthase 2 both participate in activation-induced prostaglandin D2 production in mast cells

Activation of MMC-34 cells, a murine mast cell line, or bone marrow-derived mast cells by aggregation of IgE cell surface receptors or addition of calcium ionophore stimulates prostaglandin (PG) D2 synthesis and secretion. An initial rapid burst of PGD2 synthesis, complete within 30 min, is followed by a slower subsequent production of PGD2 that reaches a maximum 4 to 8 h after activation in MMC-34 cells. PG synthase 1 (PGS-1) message and protein are expressed constitutively in MMC-34 cells and are not modulated by exposure to calcium ionophore or aggregation of IgE receptors. In contrast, activation of MMC-34 or bone marrow-derived mast cells induces expression of the PG synthase 2 (PGS-2) gene. PGS-2 induction following mast cell activation is blocked by dexamethasone. The initial PGD2 burst in activated MMC-34 cells is prevented by aspirin pretreatment, suggesting that constitutive PGS-1 present in mast cells before activation is responsible for the early PGD2 production in response to activation. In contrast, the later phase of PGD2 production is blocked by dexamethasone, cycloheximide, or NS-398, a PGS-2-specific nonsteroidal anti-inflammatory drug that inhibits PGS-2 enzyme activity but not PGS-1 activity. These data demonstrate that mast cell activation results 1) in the induction of PGS-2 gene expression, and 2) in both PGS-1-dependent PGD2 synthesis and PGD2 synthesis that is dependent on the activation-induced synthesis and activity of PGS-2.

[Differential effects of isosorbide dinitrate and nitroprusside on pial vessel diameter in cats]

Changes in pial vessel diameter combined with regional cerebral blood flow (CoBF) during infusion of vasodilating drugs, isosorbide dinitrate (ISDN) 5 micrograms/kg/min and nitroprusside (NTP) 5 micrograms/kg/min, compared with haemorrhagic hypotension were studied in cats anesthetized with halothane (1.0%). Pial arteries and veins were measured by image-splitting technique and were each divided into three groups according to the reference diameter: I; < 50 microns, II; 51 < microns < 100, III; 101 < microns. With either drug, the mean blood pressure (mBP) decreased by 10-20%. There was significant decrease in cerebral vascular resistance with ISDN compared with haemorrhagic hypotension while CoBF (H2 clearance) remained unchanged. Dilatation of pial arteries depending on vessel size with ISDN was two-hold compared with haemorrhagic hypotension without any change in all veins. Consistent and significant dilation of veins (I and II) was observed only during NTP infusion. These findings indicate the differential effect of ISDN and NTP on pial arteries and veins.

The effects of dopamine infusion during operation on the postoperative liver dysfunction

Dopamine improves renal function and renal blood flow by increasing cardiac output but its effect to ameriolate postoperative liver dysfunction has not yet been defined. Effect of 3-5 microg.kg(-1).min(-1) dopamine was studied in 22 patients who had total gastrectomy (dopamine group), and was compared with 22 patients who underwent the same operation and without dopamine infusion (control group). Liver function was evaluated from serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) values. Although postoperative SGOT and SGPT values in both groups were increased significantly higher than the preoperative values, the increases in SGOT (40 +/- 14 IU) and SGPT (32 +/- 15 IU) values in the dopamine group were significantly less than those in the control group (67 +/- 27 IU, 43 +/- 19 IU) ( P < 0.05, P < 0.01).In conclusion, these results suggested that this observation might be explained by amelioration of the postoperative liver dysfunction by infusion of dopamine. Dopamine infusion at a small dose during upper abdominal surgery is beneficial for liver function.

The effects of inversed ratio ventilation (IRV) on arterial oxygenation during mechanical ventilation in patients with acute respiratory failure

We investigated the effects of inversed ratio ventilation by altering the inspiratory:expiratory (I:E) ratio and assessing the time course changes in the intrapulmonary shunting (Qs/Qt) in 14 patients with acute respiratory failure. Stepwise prolongation of the I:E ratio from 1:1.9 to 2:1 and then to 2.6 or 4:1 was applied when PEEP failed to raise the PaO2 above 80 mmHg while breathing oxygen. A significant decrease in Qs/Qt was observed following prolongation of the I:E ratio from 1:1.9 (Qs/Qt = 45 +/- 9%) to 2:1 (Qs/Qt = 29 +/- 9%) but not with further prolongation of the I:E ratio (Qs/Qt = 27 +/- 7%). Improvement of the pulmonary ventilation/perfusion imbalance became more marked with continued IRV and a significant increase in PaO2 was observed at 6 h after initiating prolongation of the inspiratory time (P less than 0.05). There were no significant changes in hemodynamics, PaCO2, or peak inspiratory pressure during IRV. This ventilatory pattern may be indicated when PEEP fails to improve PaO2, but prolongation of the inspiratory time above an I:E ratio of 2:1 did not produce a greater improvement in Qs/Qt and further increases in PaO2 did not occur after more than 10 h of IRV in our 14 patients.

[A long-term survival case of advanced gastric cancer undergoing radical gastrectomy by second-look operation after successful chemotherapy (CDDP, MMC, 5-FU)]

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor characterized by S3 (invasion of the pancreas), N3, P0 and H0. She was then treated by combined administration of cisplatinum, mitomycin C and 5-fluorouracil. A remarkable response (CR) was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation about 8 weeks after chemotherapy, a successful radical total gastrectomy with R2 (partially R3) lymphnode dissection was performed. Histological examination of the specimens, including the stomach and lymphnodes, revealed no cancer cells in any region (pCR). She had been given UFT and PSK for 4 years 4 months after reoperation. She has lived for 5 years 2 months after reoperation without any signs of recurrence or metastases.

[Clinical evaluation of protocol for the craniomandibular disorders. 2. Craniomandibular disorders according to new classification]

The purpose of this study is to clarify the actual state in the patients with extensive pathological states of craniomandibular disorders (CMDs). 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were divided into 5 groups according to classification of Japanese Society for Temporomandibular Joint. The following results were obtained: 1. By classification type, the ratio was 88, 16, 8 and 2% for Type III, Type I, Type IV and Type II. Type V was not found. 2. 22% of patients were male and 78% were female. The ratio of male and female was 1:4. 3. By age group, the ratio was 34, 23, 18, 12, 11, 1 and 1% for twenties, tens, thirties, fifties, forties, sixties and seventies. CMDs was found highly in younger ages (tens and twenties). 4. The ratio diagnosed Type III was 86.9, 97.0, 88.8 and 83.3% for tens, twenties, thirties and forties. Type III was found high ratio in all ages. 5. In all patients, right TMJ with disorder 37%, left TMJ with disorder 34%, bilateral TMJ with disorder 29%. There were no difference between right and left. 6. As can be seen from the above, young individuals with CMDs were clearly high ratio and many CMDs were diagnosed Type III through all the ages. Therefore, the results of our study suggest that young CMDs patients could be increasing gradually and complicating a pathological state.

[Clinical evaluation of protocol for the craniomandibular disorders. 3. Questionnaire for the craniomandibular disorders]

The purpose of this study is to clarify the effectiveness of questionnaire which is included in the protocol designed for screening the patients with extensive pathological states of craniomandibular disorders. 100 patients, with their ages ranging from 11 to 77 years old, were selected for the study and they were classified under various disorder classification which is based on the criteria of Japanese society for Temporomandibular Joint. Statistical analysis was performed to find the relationship between the different pathological states and the results of the questionnaire. The following results were obtained: 1. The ratio of appearance on TMJ pain was as follows: Type I (100%), Type II (0%), Type III (43.8-75.0%) and Type IV (75.0%). 2. The ratio of appearance on TMJ pain on chewing was as follows: Type I (50.0%), Type II (100%), Type III (20.0-100%) and type IV (37.5%). 3. The ratio of appearance on TMJ pain on maximum opening was as follows: Type I (100%), Type II (100%), Type III (50.0-100%) and Type IV (75.0%). 4. The ratio of appearance on TMJ noise was as follows: Type I (0%), Type II (0%), Type III (40.9-81.3%) and Type IV (50.0%). 5. The ratio of appearance on the fatigue by mastication was as follows: Type I (0%), Type II (50.0%), Type III (40.0-100%) and Type IV (75.0%). 6. The ratio of appearance on bruxism was as follows: Type I (0%), Type II (0%), Type III (10.4-40.0%) and Type IV (25.0%). 7. The ratio of appearance on the stiff of jaw on awakening was as follows: Type I (50.0%), Type II (0%), Type III (20.8-70.0%) and Type IV (37.5%). 8. The ratio of appearance on the unilateral chewing was as follows: Type I (50.0%), Type II (0%), Type III (20.0-50.0%) and Type IV (62.5%). 9. There were significances among those types about each items on the questionnaire, it can be suggested that the questionnaire for screening about craniomandibular disorders was effective.

[Clinical Evaluation of protocol for the craniomandibular disorders. 1. Protocol of our department]

Craniomandibular disorders are conditions encompassing various types of dysfunction of the stomatognathic system. To define the very nature of morbidity, both differential and pathological diagnosis are absolutely necessary. At present, each medical institution in this country has its own protocol for evaluating and treating craniomandibular disorders. This makes it difficult to exchange and compare data between institutions. In this paper, a protocol worked out by our department after a series of clinical tests and study is presented, and its merits and unresolved problems are discussed.

[Comparison of intraocular penetration level of cefuzonam sodium and cefotiam after intravenous and subconjunctival injection]

We investigated the intraocular penetration of a new Cephem type antibiotic: Cefuzonam sodium (CZON) following intravenous and subconjunctival injection. CZON was administered to 28 eyes in 26 patients by 1 g intravenous injection (IV) and to 11 eyes in 10 patients by 20 mg/0.2 ml subconjunctival injection (SCI). The penetration level of CZON by the IV method was from less than 0.0025-3.35 micrograms/ml into aqueous humor, from less than 0.0025-0.315 microgram/mg into iris tissue and 2.7-157.5 micrograms/ml into serum. The penetration level of CZON by the SCI method was from less than 0.0025-12.8 micrograms/ml into aqueous humor, from less than 0.0025-0.0426 microgram/mg into iris tissue and 1.03-18.5 micrograms/ml into serum. The penetration level of CZON into aqueous humor by SCI was higher than by IV administration. In comparison with the penetration level of CZON and Cefotiam (CTM), both aqueous humor and serum levels of CTM were higher than those of CZON. These results suggested that therapeutic levels in aqueous humor effective against gram-positive and gram-negative pathogens were achieved with the 1 g IV and 20 mg SCI of CZON. However levels effective against Staphylococcus epidermidis were only erratically attained.

[A case of congenital laryngeal web with subglottic stenosis]

A severe case of congenital laryngeal web with subglottic stenosis was reported. The patient had weak crying after birth and stridor was noticed from one month old. He had tracheostomy at two month old and the incision of the web was attempted under laryngomicrosurgery with CO2 LASER, although the attempt failed due to combined subglottic stenosis. The "trough method" was applied at the age of one year. The web was incised and subglottic granulation including the excessive cartilaginous tissue was removed through a laryngotracheal fissure. A piece of silicone membrane was inserted between the vocal cords preventing from adhesion and a silicone tube stent was also inserted into the subglottic space and trachea to keep the laryngotracheal space open widely. After one month and a half, the silicon membrane and silicon tube were removed and a silicon T-tube was inserted instead of the silicon tube. The anterior wall of the laryngotracheal space was closed using a hinge flap. The patient can vocalize and does not complain of dyspnea at present, one year after the removal of the T-tube.

Prostaglandin content in human middle ear effusions

The concentrations of prostaglandins (PGs) were measured by a radioimmunoassay in human middle ear effusions (MEEs) obtained from patients with otitis media with effusions. Each sample of MEE was divided into two groups: serous effusions and mucoid ones. The main PG in both the serous and mucoid effusions was TXB2 (375 and 857 pg/ml, respectively), followed by PGE2 (173 and 459 pg/ml, respectively). Smaller quantities of PGD2 (35 and 64 pg/ml, respectively), PGF2 alpha (139 and 183 pg/ml, respectively), and 6ketoPGF1 alpha (129 and 201 pg/ml, respectively) were also found in the MEEs. The amounts of each PG in the mucoid effusions were 2 or 3 times higher than those found in the serous effusions, while protein concentrations and the profile of these PGs in the MEEs were almost the same in the mucoid and serous groups. These results suggest that PGs may play an important role as a mediator of the inflammatory responses in the pathogenesis of MEEs.

Cure of advanced gastric cancer by combined chemotherapy with cisplatinum, mitomycin C, and 5-fluorouracil

A 55-year-old female, in which an unresectable Borrmann II-type gastric cancer (moderately differentiated adenocarcinoma) extending from vicinity of the cardia to the lower portion of the corpus, with direct invasion into the pancreas and extensive lymph node metastases, confirmed by laparotomy, was treated postoperatively by 3 courses of chemotherapy with cisplatinum in combination with mitomycin C and 5-fluorouracil. A complete response was confirmed by roentgenography and endoscopy, and, at 4 months after the first operation, a total gastrectomy with radical lymphadenectomy was performed successfully. Cancer cells were not detectable histologically in the stomach specimen and in all the lymph nodes removed. One year and 5 months after the second operation she is well, showing no sign of recurrence.

Prostaglandin synthesis by the cochlea

The exogenous and endogenous syntheses of prostaglandins (PG's) by the cochlea of adult mongolian gerbils were studied in vitro. After incubation of the whole membraneous cochlea with [3H]-arachidonic acid (AA), syntheses of PGF2 alpha, 6-keto PGF1 alpha, PGE2, thromboxane (TX) P2 and PGD2 were evidenced in this order. The synthesis of radioactive PG's was almost completely inhibited by incubation with 10(-5) M indomethacin. No significant amounts of those PG's were detected by radioimmunoassay (RIA) in the cochlea obtained from animals killed by microwave irradiation at 5.0 kw for 0.8 sec. However, when the homogenate of the whole membraneous cochlea obtained from animals without microwave irradiation was incubated at 37 degrees C for 0-15 min, PGD2, PGE2, PGF2 alpha and 6-keto PGF1 alpha were found to be formed from endogenous AA in the cochlea by RIA. PG's were formed already at 0 time to considerable level (PGD2, PGF2 alpha and 6-keto PGF1 alpha, 90-120 pg/cochlea; PGE2, 370 pg/cochlea), reached to the maximum level (PGD2, PGF2 alpha and 6-keto PGF1 alpha, 170-200 pg/cochlea; PGE2, 500 pg/cochlea) at a 5-min incubation, and then gradually decreased. On the other hand, the amount of TXB2 was lower than the detection limit by RIA (less than 50 pg/cochlea) even after the incubation. The cochlea was dissected into three parts: organ of Corti + modiolus (OC + M), lateral wall (LW), and cochlear nerve (CN), and then PG's formed by these tissues were determined after a 5-min incubation of the homogenates. In the CN and OC + M, PGE2 was the major PG (100 and 160 pg/tissue, respectively), and the amounts of PGD2, PGF2 alpha and 6-keto PGF1 alpha were about 1/3 of those of PGE2. In the LW, the amounts of PGD2, PGE2, PGF2 alpha and 6-keto PGF1 alpha were about the same level (70-100 pg/LW).

Hyperunstable hemoglobin Koriyama anti-Hb Gun Hill insertion of five residues in the beta chain

A new hyperunstable hemoglobin was found in a Japanese girl who had very severe, chronic hemolytic anemia. Her parents and siblings were hematologically normal. The abnormal hemoglobin comprised a very small proportion of the total hemoglobin, although it was produced almost at the same rate as normal hemoglobin. Sequencing of an abnormal peptide which was liberated from the beta chain by hydrolysis with a protease from Staphylococcus aureus V8 disclosed the tandem insertion of a five-residue segment which included the proximal histidine at beta 92(F8).

Advanced gastric cancer successfully resected following cisplatin therapy: report of a case

A case of unresectable advanced gastric cancer was treated with cis-dichlorodiammine platinum (CDDP) at a dosage of 30 mg/day for 5 days every month after operation. After three courses of administration, examinations revealed that the tumor had disappeared, and an evaluation of complete response was made. Four months later, a second-look operation was performed; and it was found that the cancer was smaller than a thumb and could be resected radically. No significant side effects were observed during CDDP therapy.

[Successful treatment of advanced gastric cancer by combined cisplatinum, mitomycin C and 5-FU administration. A case report]

A 55-year-old woman with gastric cancer underwent laparotomy and was found to have an unresectable tumor at the MC region, characterized by S3 (invasion into the pancreas), N3, P0, H0, Borrmann-II and moderately differentiated tubular adenocarcinoma. She was then treated by combined administration of cis-dichlorodiammine platinum (CDDP), mitomycin C and 5-fluorouracil (5-FU). A complete response was confirmed by upper gastrointestinal roentgenography and endoscopy. Upon reoperation 4 months after the initial laparotomy, a successful total radical gastrectomy with R2 (partially R3) lymph node dissection was performed. Histological examination of the specimens, including the stomach and lymph nodes, revealed no cancer cells in any region.

Hyperunstable hemoglobin Toyama [alpha 2 136(H19)Leu----Arg beta 2]: detection and identification by in vitro biosynthesis with radioactive amino acids

A previously reported case of congenital Heinz body anemia was reinvestigated. Heat denaturation, isopropanol testing, PCMB precipitation, isoelectricfocusing, and reversed phase high performance liquid chromatography on the red cell lysate from the patient gave either negative, or at most, questionable results. In vitro globin biosynthesis using peripheral blood with incorporation of 3H-leucine demonstrated the production of an abnormal alpha chain at the rate of about 1/3 that of the normal alpha chain. A substitution, alpha 136(H19)Leu----Arg, was elucidated by peptide mapping and radiosequencing of an abnormal tryptic peptide. The hemoglobin consisting of the abnormal alpha and normal beta chains eluted between Hb A2 and Hb A0 in anion exchange high performance liquid chromatography. It was barely detectable by this method, comprising less than 1/1000 of the amount of Hb A0, although it was produced at a level of 1/3 of that of HB A0 in terms of radioactivity. The daughter of the propositus was similarly afflicted and produced the same abnormal alpha chain. The son, who also produced the abnormal alpha chain, was essentially free from hemolytic manifestation. His red cells were microcytic and showed an alpha/beta synthetic ratio of over 2.

Clinical studies on serum immunosuppressive acidic protein (IAP) and ferritin in gastric cancer patients: with special reference to preoperative value and influence of surgical stress

Serum IAP and ferritin values were measured preoperatively in 83 resectable gastric cancer patients. IAP was significantly higher in them than in normal subjects, and increased gradually with progression of cancer, and the values at stages III and IV were significantly higher than that at stage I. It was significantly higher in the cases of n(+) than in those of n(-), and in the cases of noncurative resection than in those of curative resection. Ferritin was significantly higher in them than in normal subjects and mammary cancer patients, and in males than in females, and the values at stages I and IV were significantly higher than that at stage III. OK-432 was serially administered pre- and postoperatively in 83 cases and only postoperatively in 33 cases. IAP increased markedly at 1 week postoperatively and was reduced gradually at 2 and 4 weeks. Ferritin increased markedly at 1 week after operation and reached the maximum value at 2 weeks and was reduced toward the value of 1 week at 4 weeks. However, these changes showed no significant difference between the both groups.

[Advanced gastric cancer successfully resected following cisplatin therapy. A case report]

A case of unresectable advanced gastric cancer (portion A, Min, S3 infiltrating into pancreas, N3, por., Borrmann III-type, hen's egg size) was treated with cis-dichlorodiammine platinum (CDDP) at a dosage of 30 mg/day for five days every month following surgery. After three courses of administration, examinations revealed that the tumor had disappeared and an evaluation of complete response was made. Four months later, a second-look operation was performed. It was found that the cancer was less than thumbsize and was able to be resected radically. No significant side effects were observed during CDDP therapy.

[Clinical study on serum immunosuppressive factors in gastric cancer patients--with special reference to preoperative ferritin levels and influence of surgical stress]

Serum ferritin values were measured preoperatively in 83 patients with gastric cancer and were found to be significantly higher than in normal subjects and mammary cancer patients. They were also significantly higher in healthy men than in women and in gastric cancer patients at stages I and IV than in those at stage III. There was no significant correlation between the serum ferritin value and various immunologic parameters. OK-432 serially administered pre- and postoperatively (A) and only postoperatively (B). The ferritin value increased markedly at one week postoperatively, reaching a peak at two weeks; at four weeks, it was reduced toward the value at one week. However, these changes in ferritin value showed no significant difference between groups A and B.

[Clinical study on serum immunosuppressive factors in gastric cancer patients--with special reference to preoperative IAP values and the influence of surgical stress]

Serum IAP values were measured preoperatively in 83 gastric cancer patients. The levels were significantly higher in cases of total, stage III and IV, n (+) and non-curative resection than in normal subjects, stage I, n (-) and curative resection. There was a significant correlation between IAP on the one hand, and IgG FcR (+) T cell, alpha 2-globulin and CEA on the other. OK-432 was serially administered pre- and postoperatively (A) and only postoperatively (B). IAP was examined at one, two and four weeks postoperatively, and the findings were compared. It was increased markedly at one week and was slightly reduced at two and four weeks. These changes in IAP showed no significant differences between groups A and B.

[Experimental study on quantitative evaluation of fatty liver by computed tomography]

Biochemical, histological and CT examinations of the liver were performed in 32 rabbits on significance of measuring CT values in the diagnosis of fatty liver. In 2 groups of rabbits, in which 2g/kg/day and 4g/kg/day of fat emulsion were administered intravenously for 4 weeks respectively, post-treatment reduction in CT value of light degree was observed. In a group, in which 8g/kg/day were given, there was a sufficient reduction in CT value for giving diagnosis of fatty liver of moderate degree. Significant correlation was found between changes in CT value of the liver on the one hand and contents of triglyceride, total cholesterol and cholesterol ester in the liver on the other hand, while there was, no significant correlation between changes in CT value and contents of phospholipid, protein and water. Significant correlation was found between changes in CT value of the liver and degrees of histological fat accumulation in the liver cells. It has been evidenced experimentally that prolonged administration of fat emulsion may cause fatty liver, and that measurement of CT values of the liver is a non-aggressive method of diagnosing fatty liver.

Pulmonary embolism as a complication of transfemoral arteriography--incidence, symptoms, and prevention

In order to evaluate the pulmonary embolism as a complication of transfemoral arteriography, we performed lung perfusion scintigrams before and after arteriography in consecutive 120 patients. Of the initial 60 patients who did not receive subcutaneous low-dose heparin, 19 (32%) demonstrated new pulmonary perfusion defects. There was no significant difference in regard to the incidence of new defects with or without right heart catheterization. On the other hand, in the latter 60 patients who received prophylactic heparin, the incidence of new defects decreased to 10%, without increasing clinically important bleeding. We believe that the source of emboli is from the leg vein thrombosis due to compression of the groin and subsequent bed rest. These data suggest that pulmonary embolism is a more common complication of transfemoral arteriography than previously appreciated and low-dose heparin is useful in reducing this complication.

Quantitative evaluation of fatty liver by computed tomography in rabbits

Biochemical, histologic, and computed tomographic (CT) examinations of the liver were performed in 32 rabbits in which fatty liver was induced by prolonged intravenous fat infusion. In two groups of rabbits, in which 2 and 4 g/kg/day of fat emulsion was administered, respectively, posttreatment reduction in CT value of mild degree was observed, but the reduction was insignificant from the standpoint of diagnosis from CT images. In the group that received 8 g/kg/day of fat emulsion, posttreatment change in CT value was -14.9 +/- 5.1 H, a sufficient reduction for a diagnosis of fatty liver of moderate degree. No significant change in CT value was seen in the no-treatment group or in the group in which 80 ml/kg/day of normal saline solution was infused for 4 weeks. Reduction in CT value in fatty liver might be due largely to accumulation of triglyceride and cholesterol in the liver cells. Significant correlation was found between changes in CT value of the liver and degrees of histologic fat accumulation in the liver cells. Consecutive measurement of CT values of the liver during prolonged intravenous hyperalimentation is a nonaggressive method of diagnosing fatty liver.