QT-prolonging class I drug, disopyramide, does not aggravate but suppresses adrenaline-induced arrhythmias. Comparison with cibenzoline and pilsicainide

We investigated the effects of class I antiarrhythmic drugs on corrected QT (QTc) interval and adrenaline-induced arrhythmias in halothane-anaesthetized, closed-chest dogs. For this purpose, we plotted a dose-response curve for adrenaline by calculating the arrhythmic ratio, which is the number of ventricular ectopic beats induced by adrenaline divided by the total heart rate, and observed the changes in the arrhythmic ratio-adrenaline dose relation before and after administration of class I drugs. Disopyramide and cibenzoline decreased the arrhythmic ratio induced by adrenaline. Disopyramide prolonged the QTc interval by 20% (P<0.01), but cibenzoline did not. Pilsicainide prolonged the QTc interval (12%), but this drug did not change the arrhythmic ratio. These results indicate that in contrast to the class III drugs which we have reported earlier, i.e. 1, 3-dimethyl-6-2-[N-(2-hydroxyethyl)-3-(4-nitrophenyl)-propylamino]eth ylamino-2,4 (1H,3H)-pyrimidinedione hydrochloride (MS-551), 1-(2-amino-4-methanesulfonamidophenoxy)2-[N-(3, 4-dimethoxyphenethyl)-N-methylamino]ethane hydrochloride (KCB-328) and E-1-[(5-(4-chlorophenyl)-2-furanyl)methylene]amino-3-[4-(4-methyl-1 -piperazinyl)butyl]-2,4-imidazolidinedione dihydrochloride (azimilide), class I drugs do not aggravate adrenaline-induced arrhythmias even though some drugs prolong the QTc interval.

The long-term follow-up of a highly myopic patient with a macular vortex vein

We followed a highly myopic patient with a macular vortex vein for 11 years. His refraction was -12D OU at age 10 years when the vein was first observed ophthalmoscopically in the left eye. Eleven years later, his myopia had progressed (4 diopters OD; 8 diopters OS), and the axial lengths were elongated (+1.8 mm OD; +2.7 mm OS). The macular vortex vein was dilated and tortuous. Indocyanine green angiography revealed the outflow route of this vein in the posterior pole, where both nasal and temporal posterior choroidal venous blood collected. Computed tomography showed that the vein left the eyeball directly and coursed along the optic nerve 5 mm posterior to the optic disc. A major collecting channel of posterior choroid outflow in some highly myopic eyes, a macular vortex vein may be formed at a relatively early age, and continue to enlarge, with elongation of axial length and progression of myopia.

Adjuvant chemotherapy after complete resection in non-small-cell lung cancer. West Japan Study Group for Lung Cancer Surgery

PURPOSE

We performed a study to determine whether postoperative mild chemotherapy to maintain the patient's quality of life (QOL) and immunoactivity could also prolong survival.

SUBJECT AND METHODS

From December 1985 to July 1988, 323 patients with completely resected primary non-small-cell lung cancer (stage I to III) were enrolled. The subjects were randomized into three treatment groups, as follows: cisplatin (CDDP) 50 mg/m2 body surface, vindesine (VDS) 2 to 3 mg/kg body weight for three courses, and 1-year oral administration of tegafur (FT) plus uracil (UFT) 400 mg/kg body weight (CVUft group, 115 patients); 1-year oral administration of UFT 400 mg/kg body weight (Uft group, 108 patients); or surgical treatment only (control group, 100 patients).

RESULTS

The overall 5-year survival rates were 60.6% for the CVUft group and 64.1% for the Uft group versus 49.0% for the control group. The results of statistical testing were P = .053 (log-rank test) and P = .044 (generalized Wilcoxon test) among the three groups, P = .083 (log-rank) and P = .074 (Wilcoxon) between the CVUft and the control groups, and P = .022 (log-rank) and P = .019 (Wilcoxon) between the Uft and the control groups, which indicates higher survival rates in the CVUft and the Uft groups compared with the control group. A multivariate statistical analysis on prognostic factors using Cox's proportional hazards model was performed with the following results: P = .037, hazards ratio = 0.64 with a 95% confidence interval (CI) of 0.42 to 0.97 (control v CVUft group); and P = .009, hazards ratio = 0.55 with a 95% CI of 0.36 to 0.86 (control v Uft group).

CONCLUSION

Significantly favorable results were obtained in the CVUft and Uft groups compared with surgery alone. These data showed significant prognostic advantages in the postoperative adjuvant chemotherapy groups.

Experimental application of polyvinyl alcohol-silica for small artificial vessels

Polyvinyl alcohol-silica (PVA-SiO2) composite and heparinized PVA-SiO2 were examined in vitro and in vivo as materials to coat artificial vessels to be used for the replacement of small arteries. PVA-SiO2 was observed to prolong coagulation time and on heparinized PVA-SiO2 surfaces no blood coagulation was noticed after a period of two days using the Lee-White and plasma recalcification methods. After placing non-coated and coated surfaces in contact with blood components in vitro and in vivo, the degree of blood component adhesion was greater in non-coated woven Dacron than in PVA-SiO2 coated Dacron. The degree of adhesion was even less in heparinized PVA-SiO2 coated Dacron. Furthermore, artificial vessels made of these 3 types of materials were used to replace parts of the canine abdominal aorta and were removed one and a half years later. Patency rates were as follows: non-coated 2/7, PVA-SiO2-coated 4/7, heparinized PVA-SiO2-coated 8/12. The inner surfaces of these prostheses were observed with light microscopy and scanning electron microscopy. Intima formation was thinner on the PVA-SiO2 composite surfaces than on the control surfaces. Heparin acted as a local anticoagulant and PVA-SiO2 limited intima formation. This report showed that PVA-SiO2 composite coated surfaces can be effective for small artery replacement due to good tissue affinity and anticoagulability.

Chronic pulmonary infection caused by Mycobacterium terrae complex: a resected case

A case of localized cavitary disease in lung with multiple isolations of Mycobacterium terrae complex from the patient's sputum is presented. The patient's past history and clinical tests supported his immunologic competency. Prolonged cavitary disease with persistent positive sputum led him to submit to right lower lobe resection after 5 months of chemotherapy. Innumerable isolates of the same mycobacteria from the resected cavity with a compatible histopathologic finding supported Mycobacterium terrae complex as the definitive etiologic agent in this case.

[Surgical treatment of metastatic lung tumors]

Surgical treatments were performed in 88 cases of metastatic lung tumors, where 5 years survival rate in all resected cases was 37.5%. We report our principles on the surgical treatment for metastatic lung tumors. First of all, the biological characteristics of the primary lesion is among the most important factors in considering the indication for the surgical treatment in metastatic lung tumors. For example, chemotherapy must be the first choice in treating lung metastasis of choriocarcinoma, and hormone therapy in lung metastasis of mammary carcinoma. On the other hand, such tumors as osteogenic sarcoma, soft tissue sarcoma, colorectal carcinoma and Grawitz's tumor, should be treated by surgery. Another point in the surgery of the metastatic lung tumor is the choice of the mode of operation for the solitary metastatic tumor according to tumor type. As a principle, partial or segmental resection is preferably chosen for metastatic lung tumor. However, the location of the lung tumor, tumor size, hilar lymph node metastasis and the pattern of invasion to the surrounding lung tissue must be considered to decide the surgical procedure. From these considerations, the segmental or partial resection for metastatic sarcomas and the lobectomy for the metastatic carcinomas are appropriate in general.

The in vitro and in vivo behavior of urokinase immobilized onto collagen-synthetic polymer composite material

With a view to developing biomaterials for semipermanent substitution, we have studied a composite material constituted with collagen and a synthetic polymer which possesses high tissue compatibility. This collagen-synthetic polymer composite was applied as a support for immobilization of enzymes for the purpose of providing a material surface with biological function. The enzymes, urokinase and trypsin, were successfully bound to the collagen membrane layer which had been activated by acyl azide formation of its carboxyl groups. The enzyme-bearing composite material showed excellent catalytic activity toward a protein substrate as well as a low-molecular-weight synthetic substrate. The immobilized urokinase was characterized enzymatically and compared with native urokinase. The apparent affinity of immobilized urokinase for the substrate was slightly decreased, but its intrinsic kinetic properties were not significantly affected. No decrease in its esterase activity was observed both on repeated use and on long-term storage, and its fibrinolytic activity was stable on heat or disinfection treatment. When this urokinase-bearing composite material was applied into rabbit blood vessels, its in vivo fibrinolytic activity was maintained. Thus, enzyme-collagen-synthetic polymer composites may find wide application for biomaterials and artificial organs as functional biomaterials.

Delayed hypersensitivity in mice induced by intravenous sensitization with sheep erythrocytes: evidence for tuberculin type delayed hypersensitivity of the reaction

Delayed hypersensitivity (DH) reaction can be induced in mice by intravenous sensitization with sheep erythrocytes (SRBC). However, as the sensitizing procedure is quite different from a usual mode of sensitization for DH using complete Freund's adjuvant (FCA), the nature of this reaction has been a matter of controversy. In an attempt to characterize this reaction, we placed special interest on two possibilities regarding the nature of this reaction; Jones-Mote reaction or tuberculin type DH. From the kinetics study on the DH after challenge, the DH reaction to SRBC in mice by intravenous sensitization was clearly distinguished from the Arthus reaction. The dose-response pattern of this reaction also suggested that the contribution of Arthus reactivity to delayed reactivity was negligible. Cell reconstitution experiments revealed this DH to be quantitatively thymus cell dependent. Furthermore, this DH required macrophages at its manifestation stage, and appearance of basophil infiltration at the lesion was absent. In addition, strain difference and ageing of host mice influenced the DH reaction in exactly the same fashion in which these factors influence the tuberculin type-DH induced by subcutaneous sensitization with methylated human serum albumin (MHSA) in FCA. Taken collectively, it was concluded that this DH reaction can be categorized as the tuberculin type.

Studies on composites of collagen and a synthetic polymer. Second report - mode of reaction of a laminar composite with living tissue, and results of long-term implantation

We have been studying composites of synthetic polymers and proctase-treated bovine collagen (telopeptide-poor collagen). In a previous paper, it is described that one of our composites appears to have a high tissue affinity, because it was found under a scanning electron microscope, well bonding the living tissue 6 weeks after implantation in the rabbit subcutaneous tissue. In the present study, the composites were also implanted in the subcutaneous tissue in rabbits to observe the mode of its bonding to the living tissue, and at the same time the bonding force was measured at various intervals during a period of 1.5 years, to observe the degree and duration of the effect of the composition, and further to study the optimal conditions for preparation of such a composite. As a method of composition, ultraviolet radiation and glutaraldehyde treatment were also comparatively examined, besides gamma-radiation that had been employed in a previous study. As the results, it is revealed that the composite bonds to the living tissue in such a manner that a portion of the collagen part is digested and absorbed to be replaced by the invading connective tissue and a part of collagen near the surface of the synthetic polymers had escaped digestion to combine with the rabbit's own collagen fiber. From these results we like to insist that the mode of reaction of our composites may be similar to real organization and be different in natur from mere encapsulation which was shown by the artificial materials hitherto in use to be considered to have a good tissue affinity. Therefor we think now the encapsulation is pseudoorganization. It is also shown that the bonding force of the composite to the living tissue and its duration depend chiefly on the degree of swelling, that is, the degree of intermolecular cross-linking, of the composed collagen part. Out of the gamma-radiated composites, those radiated 1--3 Mrads proved desirable in both tissue affinity and duration of tissue bonding, with a potent bonding force remaining effective even 1.5 years later, while the composite radiated with 5 Mrads or more proved poorer in these properties because of destruction of the collagen part, vastly varying in the properties. By ultraviolet radiation, it was easy to control the degree of swelling of collagen part with the radiation dose, however, this method gave a lower bonding force and a shorter duration of the force than gamma-radiation. The glutaraldehyde method allowed the collagen to remain over a long time, but gave the composite less tissue affinity than the other two methods.

Studies on copolymers of collagen and a synthetic polymer. First report--experimental study on biocompatibility of laminar copolymers of collagen and a synthetic polymer

To develop biomaterials for semiparmanent substitution, we are studying copolymers of collagen and a synthetic polymer. In this study, in order to test tissue compatibility, the laminar copolymers were prepared from bovine collagen treated with proctase to remove telopeptides and synthetic polymers such as polyethylene, polyvinylalcohol, silicon gum etc., by the OKAMURA-HINO metthod, namely polymerization achieved by the introduction of cross-lincages, applying plasma discharge and gamma-irradiation. These copolymers were implanted into dorsal subcutaneous tissue in rabbits and removed after 1, 2, 3, 4 and 6 weeks to be examined by light microscope and electron microscope. One or two weeks after implantation, we observed that a large number of fibroblasts gathered on the surface of the grafted collagen. After 3 or 4 weeks, bridges of collagen fibrils were observed between the copolymers and rabbit tissue. These copolymers were firmly adhered to the tissues and separable only with difficulty. These results showed that the copolymers maintain the capacity for extreme strong bonding for at least 6 weeks and possess high tissue compatibility. From that we concluded copolymers are useful as a biomedical material.

A cooperative study of sarcoidosis in Asia and Africa: descriptive epidemiology

An eight-nation cooperative epidemiological study revealed the Asian and African features of sarcoidosis. Almost every country reported from several to less than 30 cases, except for Japan which had already collected over 3,000 cases. Not a single case was found in the mass x-ray surveys conducted by several countries on a large scale (Tables 1 and 2). Although the number of the cases included in this study were small, this information is the first of this kind for Asia and Africa.