Clinically safe dosage of felypressin for patients with essential hypertension

Hemodynamic changes were evaluated in patients with essential hypertension when felypressin of various concentrations was administered. The parameters studied were systolic pressure, diastolic pressure, heart rate, left ventricular systolic phase, and endocardial viability ratio. Results showed that blood pressure tended to increase, and the value of 1/pre-ejection period2 (PEP2) tended to decrease, upon administration of 3 ml of 2% propitocaine containing 0.06 international units/ml (IU/ml) of felypressin. Significant increase of blood pressure and decrease in 1/PEP2 was noted upon administration of 3 ml of anesthetic solution containing 0.13 IU/ml of felypressin. No ischemic change of the myocardium was detected even with the highest felypressin concentration (3 ml of 2% propitocaine containing 0.25 IU/ml of felypressin). These results suggest that the clinically safe dosage of felypressin for patients with essential hypertension is approximately 0.18 IU. This amount is equivalent to 6 ml of 3% propitocaine with 0.03 IU/ml of felypressin, which is a commercially available local anesthetic for dental use. It seems that the decrease in 1/PEP2 that occurred during blood pressure increase was due to the increase in afterload caused by contraction of the arterioles. Although in the present study no ischemic change was noted, special care should be taken to prevent myocardial ischemia in patients with severe hypertension.

Difference in cytokine production in acute and chronic rejection of rat lung allografts

In Brown Norway to Lewis rat lung transplantation, short-term administration of cyclosporine produces permanent adoption of allografts; however, the adopted grafts show symptoms of chronic rejection. To clarify the difference in cytokine production in acute an chronic rejection of the allografts, an immunohistochemical study was performed. In acute rejection, positive cells for respective cytokines were observed in infiltrating cells, increasing in number as the days after transplantation passed, and reaching a maximum on the fifth day. The strongest reactivity was observed perivenously. In chronic rejection, TNF-alpha positive cells were observed in the perivascular and peribronchial regions, especially around class II positive epithelia. The number of positive cells was, however, less than that in the vascular phase of acute rejection. Few cells were positive for IL-1 beta, IFN-gamma and, unexpectedly, for IL-4. These facts indicate the functional difference of infiltrating cells between acute and chronic rejection.

A dose-response relationship between the frequency of p53 mutations and tobacco consumption in lung cancer patients

Mutations of the p53 tumor suppressor gene are frequent in lung cancers. It is suggested that p53 mutations are associated with smoking-induced lung carcinogenesis. We examined p53 mutations in 53 lung cancers by analyzing reverse transcription-polymerase chain reaction-single strand conformation polymorphism (RT-PCR-SSCP) to ascertain the association between p53 mutations and smoking. Twenty-five (47%) of 53 lung cancers carried p53 mutations. A discriminant analysis showed that the Brinkman index (0.156) and gender (0.140) significantly influenced p53 mutations. Furthermore, there was a dose-response relationship between the quantity of cigarettes consumed and the frequency of p53 mutations in lung cancer patients (P < 0.001). In patients with adenocarcinoma, the frequency of p53 mutations correlated with the amount of the tobacco smoked (P < 0.05). We suggest that the p53 gene is a target of particular carcinogen in tobacco smoke.

In vivo effect of prednisolone on release of leukotriene C4 in eosinophils obtained from asthmatic patients

We investigated the release of leukotriene C4 from eosinophils of asthmatic patients who were treated with or without intravenous prednisolone. The mean level of LTC4 in the supernatant of A23187-stimulated eosinophils obtained from asthmatic patients during an attack was significantly lower with intravenous prednisolone than without prednisolone treatment. Findings suggest that intravenous prednisolone inhibits the release of LTC4 from the eosinophils of asthmatic patients by acting on these cells in vivo.

[Evaluation of oxygen insufflation to non-ventilated lung during one-lung anesthesia]

To prevent hypoxemia during one-lung anesthesia, we have devised an oxygen insufflation machine which can insufflate oxygen (0.2-10 l.min-1) and apply CPAP (0-30 cmH2O) selectively to the non-ventilated lung. In all the 8 patients, arterial oxygen tension was maintained above 100 mmHg by using this machine, and was increased significantly from 76.2 +/- 11.2 mmHg (mean +/- SD) during one-lung anesthesia to 118.9 +/- 25.2 mmHg during the use of this machine. In conclusion, the machine prevents hypoxemia effectively during one-lung anesthesia without hindering surgical manipulations.

[An evaluation study on arbekacin for MRSA-infectious diseases including pneumonia, septicemia and others]

Availability of arbekacin (ABK) was analyzed in the chemotherapy of 24 MRSA-infected patients with symptoms of pneumonia (12), sepsis (6) and others (6). Most patients had background diseases such as malignant tumors or cerebrovascular disorders. 47% (7/15) of them were immunologically abnormal. 17 of them had been previously treated with cephems, imipenem, minocycline or fosfomycin. The ABK therapy was performed with doses ranging 50-400 mg a day, divided into 1-3 times (mostly 100 mg x 2), and for 5-24 days. (18 patients were treated between 5 and 14 days). 14 patients (58%) received combined therapy with other antibiotics (mostly with beta-lactams, 12). The clinical efficacy rate of the ABK therapy was 62% (good, 13; fair, 4; ineffective, 4; unknown, 3). The bacteriological efficacies were: eradicated, 7 (44%); decreased, 4; no change, 5; unknown, 8. Side effects were found in 3 patients (oliguria, 2; eruption due to drug, 1) and one case resulted in serious renal disorder. Abnormal laboratory data were found in 7 cases. Above results have indicated that ABK is a useful antibiotic in chemotherapy of MRSA-infections.

Intractable chest pain in a patient whose postpneumonectomy space was managed with sulfur hexafluoride

A 50-year-old man who had undergone right pneumonectomy 1 year previously was referred to our department following the sudden onset of severe chest pain. Since the operation, his postpneumonectomy space had been managed with sulfur hexafluoride. On admission, the pressure in the postpneumonectomy space was found to be more than +60 cmH2O. The chest pain was relieved after the sulfur hexafluoride had been drained and the pressure released. Thus, it is advisable to inject sulfur hexafluoride stepwise into the postpneumonectomy space of patients with long-standing fluid accumulation.

Management of postpneumonectomy syndrome by intrapleural injection of sulfur hexafluoride. Case report

Left postpneumonectomy syndrome was managed by injection of sulfur hexafluoride (SF6) into the pleural space. This measure permitted irradiation of a contralateral, second primary lung cancer without resulting pulmonary fibrosis. Such use of SF6 may be an option for prophylaxis against postpneumonectomy syndrome.

The Tokyo Metropolitan Home Vision Screening Program for amblyopia in 3-year-old children

In August 1989, the Tokyo Metropolitan Government officially began a vision screening program for children aged 3 years 1 month. A 1988 pilot study of 1,303 children this age disclosed five cases (0.38%) of amblyopia. The home vision test, which uses picture cards of familiar figures, proved to be an efficient and inexpensive method of screening when incorporated into the existing health-check program for 3-year-old children. In the initial eight months of the program, 21,906 children were screened. Of these, 419 children (1.9%) were referred to an ophthalmologist for follow-up, and amblyopia was detected in 41 children (0.19%).

[Three cases of intramural cyst of the esophagus with ciliated epithelium]

We had 3 cases of intramural cyst of the esophagus with ciliated epithelium. In Case 1, 13-year-old man, the cyst was lined with ciliated columnar epithelium and had a smooth muscle layer. In Case 2, 37-year-old female, the cyst was lined with ciliated stratified epithelium and had some layers of smooth muscle. In Case 3, 42-year-old male, the cyst was lined with ciliated columnar epithelium and had a smooth muscle layer. In all cases, cartilaginous tissue was not found. They had no complaints and the abnormal shadow was found by chance Chest X-ray film. When the cyst did not have typical diagnostic criteria, clear division into esophageal cyst or bronchogenic cyst is difficult. The bronchus and the esophagus are of the foregut origin, so we suppose the middle type cyst, between esophageal and bronchial, may exist. In Case 2, the cyst was diagnosed as esophageal, because it had some muscle layers. But in Case 1 and Case 3, as the cyst did not have typical diagnostic criteria, we diagnosed them as the inclusion cyst of the esophagus, not as esophageal, not as bronchogenic.

Measurement of leukotriene C4 and D4 in arterial blood of asthmatic patients during remission

We measured the amounts of leukotriene C4 and D4 in the arterial blood of asthmatic patients during remission and compared these with the amounts of leukotrienes in the arterial blood of asthmatic patients during acute asthma, which had been reported in our previous study. Leukotriene C4 and D4 was detected in five patients during remission at 50.68 +/- 8.28 and 36.68 +/- 17.31 pg/mL (mean +/- SD), respectively. In five control subjects, the amounts of leukotriene C4 and D4 were 78.22 +/- 34.65 and 55.06 +/- 13.54 pg/mL (mean +/- SD), respectively. As cited in our previous report, the amounts of leukotriene C4 and D4 in arterial blood of asthmatic patients during acute asthma were 523.33 +/- 737.06 and 495 +/- 304.48 pg/mL. Hence, there were no significant differences in the leukotriene C4 and D4 values between asthmatic patients during remission and control subjects, whereas there was a significant difference in the leukotriene D4 values between asthmatic patients during acute asthma and, asthmatic patients during remission or control subjects (P less than .01). In addition, the leukotriene C4 values in asthmatic patients during acute asthma were larger than in asthmatic patients during remission or control subjects without a significant difference. The amounts of leukotriene C4 and D4 in arterial blood of asthmatic patients may reflect the degree of severity of acute asthma.

[Respiratory distress after endotracheal insufflation of baby powder in dogs]

The cause of delayed respiratory distress after endotracheal insufflation of baby powder was investigated in dogs. Ten dogs were divided into 2 groups. In the insufflation group (n = 6), baby powder 1g.kg-1 was insufflated through an endotracheal tube under controlled mechanical ventilation. In the control group (n = 4), artificial ventilation was continued for 36 hours without insufflation of baby powder. PaO2 in the insufflation group fell until 1 hour, and then improved until 12 hours after the insufflation. But PaO2 fell again after 12 hours, and all dogs died by 36 hours after the insufflation. Pathological examination of the lungs of the insufflation group revealed gram-negative bacillus pneumonia, but no pneumonia occurred in the control group. Gram-negative bacillus was not detected in the baby powder, but Acinetobacter calcoaceticus was found from the tracheal swabs of the dog. Therefore, delayed respiratory distress was thought to have been caused by A. calcoaceticus pneumonia. It was concluded that A. calcoaceticus, which comprises a part of the indigenous flora of the respiratory tract of the dog, finally caused pneumonia and death of the dogs after baby powder insufflation because baby powder had damaged the lung's defence of bacterial clearance.

Measurement of leukotriene B4 in arterial blood of asthmatic patients during wheezing attacks

To investigate whether leukotriene B4 is present in the arterial blood of asthmatic patients during wheezing attacks, 20 ml of arterial blood was drawn from the inguinal artery of five patients. Leukotriene B4 was detected in all five individuals, and its identity was confirmed by a combination of high pressure liquid chromatography and radioimmunoassay techniques. The concentration of leukotriene B4 was 48.34 +/- 16.27 pg ml-1 (mean value +/- SE). However, in five control subjects the leukotriene B4 concentration was found to be 9.43 +/- 5.44 pg ml-1. Thus there was a significant difference between the two groups (P less than 0.05). These results suggest that leukotriene B4 may be important in elucidation of the pathogenesis of bronchial asthma.

Effects of ozone exposure on experimental asthma in guinea pigs sensitized with ovalbumin through the airway

As ozone (O3) is known to cause airway inflammation and hyperresponsiveness, we examined the effects of O3 exposure (1, 3, or 5 ppm, 2 h) on sensitization and provocation in guinea pigs sensitized with ovalbumin (OA) through the airway. In groups exposed to O3 before sensitization, 5 ppm increased the production of IgG1 antibodies and decreased the OA sensitization threshold from 0.01 to 0.002%. In those exposed before provocation, 1, 3, or 5 ppm of O3 decreased the OA provocation threshold from 0.5 to 0.02%, and this enhancement appeared to depend on airway hyperresponsiveness. We conclude that O3 exposure may play an important role in causing asthmatic attacks rather than enhancing allergic sensitization.

Malignant peripheral nerve sheath tumor (MPNST) showing perineurial cell differentiation

We report a malignant peripheral nerve sheath tumor (MPNST) showing the unusual immunohistochemical feature of epithelial membrane antigen (EMA) immunoreactivity in a 52-year-old man. The tumor, located in the left paravertebral muscles, was composed of both cellular and myxoid areas. Spindle-shaped tumor cells were arranged in longitudinal cell cords, in a storiform pattern, and in whorled structures. Ultrastructurally, the tumor cells had many interdigitating cell processes, primitive cell junctions, and discontinuous external laminae. These histological and ultrastructural features were most consistent with those of an MPNST; but on immunohistochemistry, the tumor cells reacted for epithelial membrane antigen rather than for S-100 protein or Leu-7. Because EMA-immunoreactivity was recently demonstrated in perineurial cells, we concluded that the tumor was an MPNST mainly composed of tumor cells showing perineurial cell differentiation.

Epithelial differentiation in synovial sarcoma. Correlation with histology and immunophenotypic expression

The epithelial properties of the cells in six cases of synovial sarcoma, five biphasic and one monophasic, were examined. Epithelial cells formed well demarcated glandular nests with a multi- or single-layered lining, poorly defined nest-like clusters, or appeared as scattered single plump cells in a spindle-cell stroma. Keratinization was seen in multi-layered epithelia, and was suggested in single-layered epithelia from the presence of some enlarged eosinophilic cells. Immunohistochemically, epithelia lining glands showed reactivity for both low- and high-molecular-weight (MW) cytokeratins, and the reactions for both were strongest in keratinized cells. Clustered or single plump cells showed low-MW cytokeratin reactivity. All epithelial cells were negative for the largest cytokeratin (no. 1), and occasionally stained positively for vimentin. Spindle-shaped stromal cells usually stained positively for vimentin only. Type IV collagen was distributed linearly around well circumscribed epithelia, but not around poorly defined epithelia or plump cells. Epithelial membrane antigen was distributed linearly along glandular spaces and irregularly or granularly in clustered plump cells. The immunophenotypic epithelialization in synovial sarcoma was restricted, but showed considerable correlation with the histological grade of differentiation.

CEA and CA 19-9 in benign pulmonary or mediastinal cystic lesions

Serum carbohydrate antigen (CA) 19-9 was present at high levels in pulmonary sequestration, mediastinal bronchogenic cysts, and mediastinal mature teratomas. The fluid in the cysts of the lesions contained a high level of CA 19-9. After operation, the titer of serum CA 19-9 returned to normal ranges. Histological studies showed that mucosal epithelium stained positively for CA 19-9. We speculate that CA 19-9 concentrated in the cystic lesion might flow into the peripheral blood. Carcinoembryonic antigen (CEA) was also present at high levels in the cyst fluid. CEA was positively stained in the epithelial cells using a polyclonal antibody but not a monoclonal antibody. The CEA detected at high concentration in the fluid was considered to be immunologically cross-reacting CEA.

Pulmonary leiomyomatosis showing endobronchial extension and giant cyst formation

A 49-year-old woman who had previously undergone hysterectomy was found to have multiple pulmonary masses and cysts and experienced respiratory failure. Bronchoscopic study revealed an endobronchial mass obstructing the left main bronchus and protruding into the trachea. She was treated with an endoscopic laser to eliminate the airway obstruction. After recovery from the respiratory failure, two-stage thoracotomies were performed at six-month intervals. The endobronchial mass originated from a tumor in the left basal segment. The histologic findings on the cysts and nodules of both lungs were compatible with fibroleiomyoma. The final diagnosis was pulmonary leiomyomatosis with myoma uteri.

Cat scratch disease. An epidemiological and ultrastructural study of lymphadenitis caused by Warthin-Starry positive bacteria

The aetiological agent of cat scratch disease (CSD) has been unknown for more than 30 years. Recently, a micro-organism clearly shown with Warthin-Starry silver (W-S) stain was found and thought to be a possible cause of the disease. In this study, 32 cases of regional lymphadenopathy histologically compatible with CSD and 20 contrasting cases of lymphadenopathy were examined retrospectively with W-S stain. W-S positive pleomorphic organisms were clearly demonstrated in 20 of the 32 suspected cases of CSD, but in none of the other cases. The onset of disease in these 20 cases with W-S positive organisms occurred between July and January. This seasonal variation in the onset of disease was highly significant (P less than 0.005) and was not due to a single epidemic. Moreover, some characteristic morphological features of the organism were found by electron microscopic observations. Ultrastructurally, the organism was a bacterium showing a chain-like arrangement, septal formation, branching and clubbed ends.

Plasma levels of leukotrienes C4 and D4 during wheezing attack in asthmatic patients

To study a role of leukotrienes (LTs) in bronchial asthma, we measured LTC4 and LTD4 in plasma of 16 asthmatics during wheezing attack and of 4 normal subjects. Plasma of arterial blood was processed by extraction using the SEP-PAK, followed by high-performance liquid chromatography (HPLC). Fractions from HPLC with elution times which corresponded to synthetic LTC4 and LTD4 were used for quantification of LTs by radioimmunoassay (RIA) and bioassay. LTC4 was detected in 13 out of 16 asthmatics by RIA (mean +/- SD, 410 +/- 630 pg/ml) and in 5 by bioassay. LTD4 was detected in 10 out of 16 asthmatics by RIA (mean +/- SD, 540 +/- 290 pg/ml) and in 7 by bioassay. No LTs were detected by either method in the normal subjects. The present study shows that LTC4 and LTD4 play a role as chemical mediators during asthmatic attack.

Paroxysmal electroencephalographic discharges during enflurane anaesthesia in patients with a history of cerebral convulsions

The electroencephalogram (EEG) was monitored through all phases of enflurane anaesthesia in dental outpatients with a history of cerebral convulsions which had been well controlled with anticonvulsant drugs. Abnormal EEG activity which differed from the background activity was observed in three patients. Their case reports are presented.