Capsaicin reduces ozone-induced airway inflammation in guinea pigs

We investigated whether neural pathways are involved in mediating ozone (O3)-induced airway inflammation. To determine this, we studied the contribution of adrenergic and cholinergic pathways to the O3-induced increase in airway vascular permeability, an indicator of airway inflammation, by measuring vascular permeability after giving guinea pigs propranolol or atropine to block these pathways. We also studied the contribution to O3-induced airway inflammation of neuropeptides localized in unmyelinated airway sensory nerves, by measuring vascular permeability after giving capsaicin to deplete neuropeptides from these nerves. We found that capsaicin reduced but did not abolish the increase in airway vascular permeability induced by 3 ppm O3 for 30 min. Propranolol and atropine had no effect on airway vascular permeability. These results indicate that neuropeptides released from sensory nerves, presumably by acting through the axon reflex, partly mediate O3-induced airway inflammation, and that adrenergic and cholinergic pathways are not involved.

[Surgery of bilateral pulmonary aspergilloma]

A 60-year-old man with cough and fever was admitted to our hospital. Chest radiography revealed multiple bullae and fungus balls in both lungs. He was treated with MCZ and FCZ for about 2 months, but the chest radiograph shadows did not improve and the fever continued. A two-stage operation was performed. The bullae were incised and the fungus balls were removed, then a muscle flap plombage was made with a pectoralis major muscle, a latissimus dorsi muscle and an intercostal muscle. The postoperative course was uneventful and respiratory function was preserved.

Effects of MS-551, a new class III antiarrhythmic drug, on programmed stimulation-induced ventricular arrhythmias, electrophysiology, and hemodynamics in a canine myocardial infarction model

We examined the effects of MS-551 (1,3-dimethyl-6-[(2-[N-(2-hydroxyethyl)-3-(4- nitrophenyl)propylamino]ethylamino] 2,4(1H,3H)-pyrimidinedione hydrochloride), a new class III antiarrhythmic drug, on programmed electrical stimulation (PES)-induced ventricular arrhythmias, the effective refractory period (ERP), intraventricular conduction, and hemodynamics in a canine myocardial infarction (MI) model. MS-551 was administered intravenously (i.v.) in two consecutive doses; the first dose (low dose) was 0.5 mg/kg/min after a bolus injection of 0.3 mg/kg, and a second dose (high dose) was 0.1 mg/kg/min after a bolus injection of 0.3 mg/kg. PES induced ventricular tachycardia (VT) or ventricular fibrillation (VF) in 10 of 12 animals. MS-551 abolished or lessened the ventricular arrhythmias in 7 of 10 animals at both doses. ERP was significantly prolonged by MS-551 in both the normal and infarcted zones in a dose-dependent fashion. Ventricular conduction of a premature excitation induced by a premature stimulation with various coupling intervals was decreased only at a coupling interval approximating that of ERP. MS-551 at either low or high dose did not significantly change the heart rate (HR), mean blood pressure (MBP), cardiac output (CO), or maximum rate of increase in left ventricular pressure (LVP) significantly. MS-551 produced a suppression of the PES-induced ventricular arrhythmias through prolongation of ERP without having any significant effect on hemodynamics in a canine MI model.

[A pilot study of induction chemotherapy with cisplatin, mitomycin C and vindesine for stage III N2 non-small cell lung cancer]

PURPOSE

The postoperative survival of patients with preoperatively identified stage III N2 non-small cell cancer (NSCLC) is poor. A pilot study of induction chemotherapy consisting of cisplatin, mitomycin C and vindesine (CMV) was undertaken in an attempt to improve the curative potential of surgery in this group of patients.

PATIENTS AND METHODS

Thirty-two patients with stage III N2a NSCLC received two cycles of CMV, (80 mg/m2 cisplatin i.v. on day 1, 8 mg/m2 mitomycin C i.v. on day 1, and 3 mg/m2 vindesine i.v. on day 1 and 8, every 4 weeks) preoperatively. The responding patients received a further two courses of CMV after surgery.

RESULTS

The response rate was 63% (20 PR). All patients underwent operation including radical mediastinal node dissection. Twenty-six resections were curative and six were absolute non-curative. The toxicity was generally mild, but there were two hospital deaths, due to bronchopleural fistula and postoperative pneumonia. Sixteen patients have shown recurrent disease up to now. When the recurrence patterns were classified by clinical response, 11 responding patients were disease-free (9-84 months), but all non-responding patients had recurrent diseases. The median survival of curatively resected patients with pathological N2 was 39 months with a 5-year survival of 29%.

CONCLUSIONS

This induction chemotherapy was well tolerated and revealed a high response rate. The current survival is obviously improved compared with the historical control, indicating that subsequent phase III clinical trials are urgently needed.

Magnetic resonance evaluation of the temporomandibular joint disc position and configuration

Although magnetic resonance imaging (MRI) is the modality of choice for evaluation of TMJ disc position, it is sometimes difficult to determine when it is displaced or reduced. The MR images of 273 Patients with a clinical diagnosis of TMJ disorders were assessed for disc position and configuration. Most (90-97%) of the slightly anteriorly displaced discs were reduced to the normal position in the open-mouth position. However, the greater part (76%) of the distorted discs was completely displaced anteriorly and without reduction. Since no distorted discs were found in the normal disc position, we conclude that discs are distorted after displacement.

Characterization of renal aldosterone receptors in genetically hypertensive rats

To investigate the aldosterone responsiveness of genetically hypertensive rats, we compared characteristics of renal cytosolic aldosterone receptors from the M strain of stroke-prone, spontaneously hypertensive rats (M-SHRSP) with normotensive Wistar-Kyoto rats (WKY). In M-SHRSP, blood pressure was elevated significantly at 6 wk of age, when their plasma aldosterone concentrations were similar to those in WKY. Decreases in urine volume and sodium excretion were also observed in M-SHRSP. At 10 wk of age, M-SHRSP plasma aldosterone concentrations became significantly higher than those in WKY. On the other hand, the concentration of renal cytosolic aldosterone receptors (type I, aldosterone specific) had already increased at 6 wk of age in M-SHRSP, with no difference in affinity, and levels remained increased thereafter. There were no significant differences in molecular weights or ionic charges of either "activated" or "non-activated" aldosterone-receptor complexes between M-SHRSP and WKY, indicating that the molecular properties were similar in both groups. These results suggest that the increased concentration of aldosterone receptors in the kidneys of M-SHRSP might increase their aldosterone responsiveness and contribute to the development of high blood pressure in these animals.

[Two cases of Morgagni's hernia]

Two cases of Morgagni's hernia comprising protrusion of the omentum alone are reported. The treated patients were 65- and 63-year-old obese women. They were referred to our hospital because of chest pain or vomiting accompanied by abnormal shadow in right cardiophrenic angle on chest roentgenogram. Computed tomogram (CT) demonstrated a mass of fat density behind the sternum for the both patients. The first patient was diagnosed as Morgagni's hernia by pneumoperitoneum, and surgical repair was done by the transabdominal approach. Magnetic resonance imaging (MRI) was carried out for the second patient, and showed intrathoracic mass lesion which was continuous with the subphrenic tissue. Although the second patient was diagnosed as mediastinal lipoma, median sternotomy revealed that the mass lesion was Morgagni's hernia. Postoperatively, both patients recovered uneventfully. The Morgagni's hernia has been reported to be about 3% of all diaphragmatic hernia. This disease may be discovered either because it causes respiratory or gastrointestinal complaints, or because an abnormal shadow in right cardiophrenic angle on a chest roentgenogram. If air-filled structures are present in the hernia, a barium study will confirm the diagnosis. In a case with a hernia containing only omentum, the diagnosis is difficult. CT has been regarded as the procedure of choice by several authors. The coronal and sagittal views of MRI can demonstrate the relationship between the herniated structures and the diaphragm, heart, pericardium. We emphasize the role of MRI for the diagnosis of Morgagni's hernia.

Combined effects of ozone and cigarette smoke on airway responsiveness and vascular permeability in guinea pigs

The effects of combined exposure to ozone and cigarette smoke on airway responsiveness and tracheal vascular permeability, compared with those of single exposure were examined in guinea pigs. Airway responsiveness was assessed by measuring the specific airway resistance (sRaw) as a function of increasing concentration of inhaled methacholine aerosol immediately, 5 hr, and 24 hr after exposure. In a parallel study, tracheal vascular permeability was quantified by measuring the tracheal extravasation of intravenously administered Evans blue dye. Neither exposure to 1 ppm ozone for 30 min nor 5 puffs of cigarette smoke increased airway responsiveness or vascular permeability at any time after exposure. Combined exposure to 1 ppm ozone for 30 min and 5 puffs of cigarette smoke caused airway hyper-responsiveness and increased vascular permeability immediately after exposure. Exposure to 1 ppm ozone for 90 min increased both airway responsiveness and vascular permeability immediately after exposure. Exposure to 10 puffs of cigarette smoke increased airway responsiveness but not vascular permeability immediately after exposure. Combined exposure to 1 ppm ozone for 90 min and 10 puffs of cigarette smoke increased both airway responsiveness and vascular permeability immediately after exposure. The combined exposure to ozone and cigarette smoke thus increased both airway responsiveness and tracheal vascular permeability to a greater extent than did exposure to a single agent, suggesting that a combination of air pollutants has a more deleterious effect both on airway responsiveness and on tracheal vascular permeability than does either agent alone in guinea pigs.

Postoperative venous thromboembolism and brain tumors: Part I. Clinical profile

Forty-six patients who underwent surgery for brain tumors were studied prospectively with 125I labeled Fibrinogen leg scans to detect postoperative venous thrombosis. The incidence of thrombosis was 72% for meningioma patients, 60% for glioblastoma patients, and 20% for brain metastasis patients. Correlation between the occurrence of venous thrombosis and the various clinical factors thought to be responsible for the high incidence of thrombosis generally failed to show statistical significance. This finding, along with the marked variation in the incidence of venous thrombosis between the different brain tumor groups, strongly suggests that biological factors play a more important role than clinical factors in determining which brain tumor patient will suffer a postoperative thrombotic event.

Reduced lysozyme in solution and its interaction with non-ionic surfactants

Reduced lysozyme at pH 2.5 bound poly(oxyethylene) alkylethers in two steps and the maximum bound amount Qmax of the surfactant reached as large as 0.5-0.7 mole per mole amino acid residue in the cooperative binding step. Binding isotherms were well superimposed when surfactant concentrations were normalized by respective values of the critical micelle concentration, cmc. In terms of the onset concentrations of the cooperative binding C*, hydrophobicity of reduced lysozyme was quantitatively defined as RT In (cmc/C*) which amounted to 670 J per mole surfactant and was unique to the protein irrespective of the kind of surfactant. Qmax could be used as another measure of the hydrophobicity of the protein. The binding isotherms were evaluated by two methods: equilibrium dialysis and surface tension. Their results were consistent with each other and rather complementary. Reduced lysozymes were molecularly dispersed at pH below 2.5 in 0.01 M NaCl but aggregation took place as pH increased. The aggregates could not be dissociated on dilution nor by the addition of nonionic surfactants but by lowering pH. The irreversible nature of the aggregation was reasonably interpreted with a model based on the 'entangled' arrangement of the beta-sheets, which could account for the irreversible aggregation of unfolded proteins in general.

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing--a randomized crossover study in comparison with placebo

With eight cases of stable exertional angina as subjects, the antianginal action and sustained effects of single 10 mg oral doses of new calcium antagonists amlodipine were assessed by treadmill exercise tests in randomized crossover trials with respect to a placebo. Exercise tests were conducted before as well as 4, 8, and 24 hours after administration, and plasma amlodipine concentration was investigated at the same times. The maximal exercise time was 299 +/- 43 seconds before as compared with 346 +/- 49 seconds 4 hours after administration and 368 +/- 50 seconds 8 hours after administration, a significant prolongation in each case (p < 0.01). Moreover, the exercise time elapsed until 1 mm of ST-segment depression, as well as the ST-segment depression measured at the same time, were both significantly improved as compared with the placebo results. The plasma amlodipine concentration reached a peak 8 hours after administration and displayed an effective level even 24 hours after administration. The value of delta PRP measured at the same time during the exercise test was also significantly reduced as compared with the placebo results, even 24 hours after administration of amlodipine. These findings supported the conclusion that single 10-mg doses of amlodipine provide stable antianginal action over a 24-hour period.

[A case of renal squamous cell carcinoma associated with giant hydronephrosis and ureteral stone: efficacy of imaging modality]

A rare case of squamous cell carcinoma of the right kidney associated with giant hydronephrosis and right ureteral stone was reported. A 60-year-old woman was referred to our department with a complaint of ileocecal dull pain. A plain computerized tomogram (CT) revealed giant hydronephrosis, and a kidney-ureter-bladder X-ray revealed a right lower ureteral stone. A right percutaneous nephrostomy was done and antegrade pyelography revealed giant hydronephrosis and a ureteral stone, but showed no intrapelvic filling defect. Under the diagnosis of right ureteral stone with hydronephrosis, right ureterolithotomy was done. However, since the inflammation did not subside after ureterolithotomy, right nephrectomy was done. The surgically removed right kidney did not show any evident tumor mass, a histological study revealed squamous cell carcinoma involving renal parenchyma. The patient received no adjuvant therapy and died 3 months after nephrectomy with sudden appearance of bone, liver and pulmonary metastases. The preoperative efficacy of imaging modalities for renal squamous cell carcinoma was discussed herein.

The clinicoradiologic predictability of perforations of the soft tissue of the temporomandibular joint

One hundred thirty-one arthrographic examinations of temporomandibular joints were performed on 119 patients. The relationships between clinical symptoms, tomographic findings, and soft-tissue perforation were examined. Perforations of the articular disk or posterior attachment were revealed in 58 joints. Joints with crepitation showed a high frequency of perforation (20 of 22). Pain in the joint area and limitation of opening correlated to disk reduction. Perforations were observed in 12 of 21 joints with continuous pain. Osseous changes were detected in 89 joints. Joints with abnormal radiodensity (erosion, sclerosis) combined with abnormal shape (pocket erosion, osteophyte formation, deformity) showed a high frequency of perforation (41 of 45), which corresponded to 84% in this study. In those cases with osseous change or crepitation, positive predictive values of perforation were both 91%. These types of osseous change and their clinical significance might predict soft-tissue perforation with high accuracy before an arthrogram is performed.

99mTc(V)-DMSA and 99mTc-MDP uptake and no 67Ga-citrate uptake in a case of primary pulmonary leiomyosarcoma

Tumor scintigraphy with 67Ga-citrate, 99mTc(V)-DMSA and 99mTc-MDP were performed on a patient with rare primary pulmonary leiomyosarcoma. While 67Ga-citrate accumulation to the tumor was not recognized, 99mTc(V)-DMSA and 99mTc-MDP scintigraphy showed relatively intense localization of the tracers in the lesion, and were very useful in suggesting the characteristics of the tumor.

[Male bladder leiomyoma: a case report]

A case of leiomyoma of the urinary bladder in a 40-year-old man is reported. Enucleation of the tumor was performed, because transurethral resection-biopsy revealed a bladder leiomyoma. Ninety nine cases of a bladder leiomyoma have been reported in Japan, but male cases are rare.

[Clinical study on cough variant asthma]

Chronic cough may be the sole presenting manifestation of bronchial asthma (reference 3; Corrao et al, 1979), and "cough variant asthma (CVA)" has been used to categorize such patients. In order to clarify the clinical picture of CVA, we evaluated the clinical history, laboratory data, sputum cytology and pulmonary function in 14 subjects (5 males and 9 females, aged 14 to 65 years) compatible with the following diagnostic criteria: (1) chronic cough persistent for more than 8 weeks, (2) no wheeze nor dyspnea, (3) no rales, (4) no past history of asthma, (5) bronchial hyperreactivity to methacholine proven by Takishima's method (reference 13), (6) effectiveness of bronchodilators against cough, (7) normal chest X-ray film, (8) afebrile and negative CRP, (9) absence of sinusitis and postnasal drip, or if present, they are proved not to be responsible for the cough, and (10) no other causes of cough such as heart disease, prescription of ACE inhibitors, current smoking. The results were as follows. 1) Many of the subjects were atopic, with positive skin tests to one or more common allergens in 10 subjects, elevated serum IgE in 4 subjects, and past history and family history of atopy in 4 and 7 subjects, respectively. 2) Respiratory infection preceded the onset of CVA in 3 subjects. 3) Cough was generally nocturnal, but 2 subjects coughed only in the daytime. 4) FEV1.0% was decreased (less than 70%) in only 2 subjects, whereas V25 was decreased (less than 80% of predicted value) in 11 out of 12 evaluable subjects, which suggested peripheral airway obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

1H-NMR spectroscopy of serum in SHN mice with and without spontaneous mammary tumours

Proton nuclear magnetic resonance (1H-NMR) spectra of serum were studied before and after the appearance of spontaneous mammary tumours in intact and anterior pituitary grafted SHN mice. In the sera of non-tumourous animals, the lipid CH2 and CH3 resonances at 1.31 and 0.88 ppm, possibly the peaks of very low density lipoprotein (VLDL), were unclear; however, such resonances were apparently observed in the sera of mammary tumour bearing mice. On the contrary, alanine, beta-hydroxybutyrate, valine and leucine, which peaked clearly in non-tumourous mice, declined greatly in tumourous mice. Livers of tumourous mice were heavier than those of non-tumourous animals. Quite similar trends in serum spectra and liver weight were observed in mice grafted with two anterior pituitaries. These findings indicate that tumour absorption of VLDL increases and other metabolic pathways are largely altered in association with mammary tumour progression. Prolactin, which is essential for mammary tumour development, had little effect on serum spectra of mice either with or without mammary tumours.

1H-NMR spectroscopy of urinary components of SHN mice in the course of spontaneous mammary tumourigenesis

Proton nuclear magnetic resonance (1H-NMR) spectroscopy of urine was studied before and after the development of spontaneous mammary tumours in SHN mice. Urinary allantoin and lactic acid levels declined from 2 weeks before mammary tumour appearance and increased with the tumour growth after its appearance. The level of component at 3.4 ppm, which reacted with Ninhydrin and was possibly assigned to taurine, continued to decline beginning 2 weeks before tumour appearance. No considerable changes were observed in urinary levels of creatine and creatinine before and after tumour development, however, these components as well as allantoin or lactic acid had positive correlations with mammary tumour size. A negative correlation was observed between the level of 3.4 ppm component and tumour size. Surgical removal of tumours resulted in an apparent decline in urinary levels of allantoin and lactic acid. At all stages, urinary allantoin level was approximately 4 times as high as the levels of lactic acid and 3.4 ppm component. All results suggest that urinary allantoin would be a good indicator for the development of spontaneous mammary tumours of mice.

[A resuscitated case of sleep apnea syndrome with cardiac arrest]

A 71-year-old man was noted to habitually snore loudly at night and have a predisposition to somnolence during the daytime. While dozing during the day, he developed cardiac arrest at the time when snoring stopped, and was resuscitated. By means of a respiration monitor, he was diagnosed as having sleep apnea syndrome (SAS) with a combination of obstructive, central, and mixed type. However, neither respiratory insufficiency nor cardiac insufficiency was observed, and there were no abnormal findings on laboratory tests and bronchoscopy. SAS complicated by cardiac arrest is usually seen in cases with concomitant symptoms such as excessive obesity, hypertension, arrhythmia, right heart insufficiency, secondary polycythemia, or mental disorder. The present case abruptly developed cardiac arrest in the absence of such symptoms. This case therefore suggests the importance of screening tests using a respiration monitor during sleep in subjects who have a loud snore or a predisposition to somnolence during the daytime. Although treatment with UPPP alone had no noticeable effect, UPPP treatment combined with sleeping in the lateral position was effective in the present case. The efficacy rate of UPPP has been reported to be 50 to 60%. The early establishment of a method for precise evaluation of the site of obstruction as well as criteria for appropriate application of UPPP are urgently required.

[Inferior vena caval resection for renal cell carcinoma: usefulness of renal venous pressure measurement]

Renal cell carcinoma with extended tumor thrombi densely adherent to the vena caval wall sometimes requires vena caval resection. If the tumor is on the right side and the collateral veins of the left renal vein are abundant, vena caval reconstruction may not be required. We recently performed radical nephrectomy and vena caval resection on 2 right renal cell carcinoma patients. To decide the necessity of vena caval reconstruction, left renal vein pressure was measured before and after clamping of the vena cava. In case 1, because the pressure was elevated from 21 cmH2O, to 61 cmH2O, total replacement with Gore-Tex graft was performed. In case 2, because the pressure change was from 22 cmH2O to 23 cmH2O, reconstruction was not performed. The most important test to decide the necessity of vena caval reconstruction is thought to be the change of renal venous pressure before and after clamping of the vena cava.

[Le Duc-Camey antireflux ureteroileal reimplantation for continent ileal reservoir]

Le Duc-Camey antireflux ureteroileal reimplantation was used on 15 patients with 30 ureters reimplanted into the ileum as part of a bladder substitution procedure (Kock pouch or ileal neobladder: U-bladder) or augmentation cystoplasty (Goodwin ileocystoplasty). In our experience, no reflux was observed, while hydronephrosis was identified in one ureter of ileal neobladder (4%). Le Duc-Camey antireflux ureteroileal reimplantation is suitable for reconstruction with the ileal reservoir.

Effects of CD-349, a dihydropyridine derivative, on contraction induced by vasoactive agents in canine basilar artery after subarachnoid hemorrhage

We investigated the effects of CD-349, a dihydropyridine derivative, on contraction induced by vasoactive agents in canine basilar artery after subarachnoid hemorrhage (SAH). Ca(2+)-induced contraction of basilar arterial strips preincubated with serotonin (5-HT, 3x10(-6)M) was potentiated in strips from SAH. However, Ca(2+)-induced contraction of arterial strips which were depolarized with isotonic K+ (64mM) was attenuated in strips from SAH. These Ca(2+)-induced contractions of the basilar arteries preincubated with 5-HT and K+ from both control and SAH dogs were significantly inhibited by CD-349 and nicardipine, both dihydropyridine derivatives. 5-HT contracted the basilar arterial strips in a concentration-dependent manner; however, the maximal contraction of the basilar arterial strips to 5-HT was enhanced in SAH. Endothelium-dependent relaxation in response to substance-P was attenuated in SAH when compared to that in control dogs. Early treatment with CD-349 (1 or 2mg/kg/day, i.m.) for 1 week reversed not only the enhanced contraction of the basilar artery in response to 5-HT but also the impairment of endothelium-dependent relaxation in response to substance-P in SAH. It is expected that CD-349 may be a useful agent for the treatment of cerebrovascular diseases such as SAH.

Changes in responsiveness of the canine basilar artery to endothelin-1 after subarachnoid hemorrhage

The effect of endothelin-1 (ET-1) on the basilar arteries from control and subarachnoid hemorrhage (SAH) dogs were examined. The maximal contraction of the basilar artery in response to ET-1 was markedly decreased in the SAH group. Treatment with 10(-8)M phorbol 12-myristate 13-acetate (PMA) reduced the contractile responses to ET-1 in the basilar arteries from control dogs. ET-1-induced contractions of the basilar arteries from control dogs were similar to those in strips from SAH dogs by the treatment with 10(-8) M PMA. Ca(2+)-induced contraction of the basilar arteries which were depolarized with isotonic K+ (64 mM) were significantly attenuated in SAH dogs. Treatment with PMA also reduced the contractile responses to Ca2+ in the basilar arteries from control dogs. These results indicate that decreased contractile responses of the basilar arteries to ET-1 and Ca2+ in the SAH group may be related to changes in the activity of the protein kinase C in vascular smooth muscle.

[A new method of intraarterial high dose chemotherapy for unresectable hepatocellular carcinoma--the effect of direct hemoperfusion under hepatic venous isolation]

We undertook hepatic artery infusion of high dose adriamycin (ADR) in three patients with unresectable hepatocellular carcinoma utilizing direct hemoperfusion (DHP) under hepatic venous isolation (HVI). 5 minutes continuous infusion of ADR at dosages of 100 and 150 mg/m2 was combined with DHP of 20 and 30 minutes, respectively. HVI was established by occlusions of suprahepatic and retrohepatic vena cava using a tourniquet tape and a cuff-cannula. During HVI, hepatic venous outflow was directed toward DHP and joined with the rest of the intra-caval blood before the centrifugal pump connected to a return cannula to the left axillary vein. Systemic levels of ADR were maintained less than 2 micrograms/ml during the treatments in three patients. The estimated drug removal rates were 72.3%, 51.2% and 31.1% respectively. Hematologic changes due to DHP were tolerable and transient. Highest values of serum transaminases were demonstrated on day 2 and rapidly recovered to the pretreatment levels within a week. Postoperative CT studies revealed also marked reduction in tumor size. We consider this method an attractive therapeutic option for patients with advanced hepatocellular carcinoma.

Extracorporeal removal of anticancer drugs in hepatic artery infusion: the effect of direct hemoperfusion combined with venovenous bypass

The effect of a new extracorporeal system combining direct hemoperfusion (DHP) with venovenous bypass was evaluated in the elimination of anticancer drugs in hepatic artery infusion. Adriamycin (3 mg/kg) and mitomycin C (1 mg/kg) were given to mongrel dogs through the hepatic artery with three different durations of 1, 10, and 20 minutes. Plasma drug levels were determined at the inlet and outlet of DHP and right external jugular vein (systemic level). Blood flow through DHP averaged 200 ml/min. In dogs without DHP (group I; n = 4), systemic levels of adriamycin and mitomycin C increased rapidly with 1-minute infusion, reaching the peak values of 6.61 +/- 2.44 (mean +/- SD) and 2.20 +/- 1.05 micrograms/ml, respectively. With DHP under single venous bypass (group II; n = 5), the peak values were reduced to 1.25 +/- 1.02 and 0.79 +/- 0.52 microgram/ml. Moreover, the peak levels were markedly reduced by DHP under hepatic venous isolation (group III; n = 6), the values being 0.41 +/- 0.15 and 0.13 +/- 0.07 microgram/ml with 1-minute infusion. The drug-removal rates were improved substantially in group III compared with group II. The longer the duration of infusion, the higher the removal rates tended to be in group III. These results indicate that effective elimination of anticancer drugs can be accomplished by this system during intraarterial chemotherapy of the liver.

[Histology and prognosis in lung cancer treatment]

In 678 cases of surgically resected lung cancer, morphological factors influencing prognosis were evaluated, especially in adenocarcinomas (283 cases) and squamous cell carcinomas (270 cases). In adenocarcinoma cases, sex, degree of differentiation, classification by cell type, lymphatic invasion, vascular invasion, pleural involvement, intrapulmonary metastasis, grade of scarring associated with a tumor, atypia of cells and mitotic index were significantly evaluated. The scoring of these factors will contribute to the clinician's decisions on the necessity and selection of post-adjuvant chemotherapy, especially even in Stage I. In squamous cell carcinoma cases, location of tumor, tumor size, lymphatic invasion, vascular invasion and pleural involvement were also significantly evaluated. In 160 patients treated by chemotherapy involving cisplatin, chemotherapeutic response in squamous cell carcinoma (39 cases) was more effective and survived longer these than in adenocarcinoma (107 cases) and large cell carcinoma (14 cases). In 233 non-small cell lung cancer patients treated by chemotherapy, there were 33 cases of long-term survival more than 2 years; that is, 8 cases (3.4%) disease-free and 25 cases (10.7%) alive with cancer. The group which remained disease-free for over 2 years, consisted only of patients with Stage IIIa or IIIb, and PR was achieved with chemotherapy and radiation. Among patients who lived over 2 years, many squamous cell carcinoma cases (5/6) remained disease-free. On the other hand, adenocarcinoma was less responsive to chemotherapy and almost all cases (24/27) were alive with cancer. The relationship between the effectiveness of chemotherapy and prognosis among histological subtypes was examined in small cell lung cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnostic value of bronchoalveolar lavage in fat embolism syndrome--a case report]

On the basis of the studies of autopsy cases and experimental animals, the pulmonary pathological findings of fat embolism syndrome (FES) have been reported to be (1) fat globules in the alveolar capillaries and the alveoli, (2) intra-alveolar hemorrhage, (3) alveolar edema and (4) foci of secondary infection. However, reports on lung biopsy in FES are rare, and no report has mentioned bronchoalveolar lavage (BAL) in FES. We experienced a case of FES, in which BAL was diagnostic. A 23 year-old man traffic accident victim was brought to our hospital by ambulance. His consciousness was clear and skeletal X-ray films revealed multiple fractures of the right femur, left tibia and left fibula. Direct traction of bilateral lower extremities was done. He remained stable subjectively, but anemia and thrombocytopenia progressed gradually in spite of blood transfusion. On the 4th hospital day severe hypoxemia, diffuse pulmonary infiltrates and petechiae in bilateral axillary lesions appeared, and FES was strongly suspected. O2 inhalation by face mask and high dose methylprednisolone administration was started. The hypoxemia improved, but pulmonary infiltrates worsened. For differential diagnosis, bronchoscopy and BAL was done on the 7th hospital day. Bronchoscopy revealed much fresh blood in the left main, upper lobe and lower lobe bronchus but no bleeding point was found. BAL fluid was bloody. The Sudan III stain and Berlin blue stain revealed several fat globules and numerous hemosiderin-laden macrophages. The presence of intra-alveolar fat globules and intra-alveolar hemorrhage was proved and definite diagnosis of FES was established.

[Extracorporeal adriamycin-removal following hepatic artery infusion: use of direct hemoperfusion combined with veno-venous bypass]

Systemic toxicity of adriamycin (ADR) has limited its high dosage application in hepatic artery infusion. We developed a new extracorporeal device combining direct hemoperfusion (DHP) and veno-venous bypass to eliminate ADR following hepatic artery infusion. Mongrel dogs were divided into three group, I: controls without DHP (n = 3), II: DHP under single venous bypass from IVC to left external jugular vein (n = 3) and III: DHP under hepatic venous isolation using veno-venous bypass (n = 5). Blood specimens were obtained to determine plasma drug levels until 60 min after ADR injection (3 mg/kg body weight, 1 min). Blood flow through DHP, which was averaged 200 ml/min in both groups II and III, was monitored with ultrasonic flowmeter. In groups I and II, peripheral ADR levels rapidly increased, reaching the peak values of 5.61 +/- 2.42 and 1.17 +/- 0.31 micrograms/ml respectively at 1 min after injection. The peak level in group III was markedly reduced, the value being 0.42 +/- 0.17 microgram/ml, which was 7.5% of the peak value of group I. The removal rates in groups II and III were 10.9 and 27.5% respectively. In conclusion, DHP under hepatic venous isolation can be an useful method to reduce systemic distribution of ADR during hepatic artery infusion.

[Two cases of thymic carcinoid]

Two cases of thymic carcinoid tumor were reported. Case 1 was 64-year-old male who was admitted to our hospital with a complaint of dyspnea. He was proved to have a huge anterior mediastinal tumor by chest X-ray and chest CT. After radiation therapy, the tumor was resected on February 5, 1981. Pericardium was partially resected and showed tumor invasion. Sixty-four days after operation, he died due to respiratory insufficiency. Case 2 was 71-year-old male who was pointed out to have an abnormal shadow by X-ray mass screening and was admitted to our hospital. Chest X-ray and chest CT revealed the presence of an anterior mediastinal tumor. Resection of the tumor was done on February 13, 1986. Although the tumor showed mediastinal lymph node metastasis and invaded to the pericardium and the right lung, it was resected completely. Cytological examination of pericardial effusion showed tumor cells at the time of resection. He is now quite well and without any evidence of recurrence 3 year and 1 months after operation. Histopathologically, the tumors of two cases consisted of relatively uniform cells with abundant clear or slightly eosinophilic cytoplasm and regularly and centrally located nuclei. Mitotic figures were occasionally seen in both cases. Many tumor cells were positively to Grimelius stain. On the other hand, Fontana-masson stain was negative. Immunohistochemically, the tumor cells were positively stained with anti-NSE and anti-GRP antibodies in Case 1 and with anti-NSE antibody in Case 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of aldosterone receptor in rat kidney cytosol by atrial natriuretic factor

We investigated the effect of atrial natriuretic factor (ANF) on aldosterone receptors in the kidney cytosol, because the binding of aldosterone to aldosterone receptors in the cytosol is considered a critical step of its action. Rat atriopeptin III was injected into male Sprague-Dawley rats (200-250 g) via the femoral vein while under pentobarbital anesthesia, and aldosterone receptors in the kidney cytosol were determined. The maximum binding capacity and dissociation constant were calculated by the Scatchard analysis. Maximum binding capacity of both types of aldosterone receptor (Type I, high affinity and low binding capacity and Type II, low affinity and high binding capacity) gradually decreased after ANF injection, reached the lowest level after 2 hours, and then slightly recovered. When more than 2.5 micrograms/kg of rat atriopeptin III was injected, the density of aldosterone receptors significantly decreased. Injection of 12.5 micrograms/kg of rat atriopeptin III decreased maximum binding capacity of Type I receptor from 42.3 +/- 2.4 (mean +/- SD, n = 6) to 22.8 +/- 3.2 femtomole/mg protein (n = 6) (p less than 0.01), and that of Type II receptor decreased from 388 +/- 46 to 285 +/- 30 fmol/mg protein (p less than 0.01). Dissociation constant of both types of receptors did not change significantly after ANF injection. Plasma aldosterone concentration showed no significant change after ANF injection, and a significant change was noted after ANF administration on aldosterone receptors in the experiments on adrenalectomized rats 7 days after operation. Furosemide had no significant effect on aldosterone receptors in both normal and adrenalectomized rats.(ABSTRACT TRUNCATED AT 250 WORDS)

[Splenic vein occlusion due to pancreatic disease: regional portal hypertension from hemodynamic points of view]

The purpose of this study is to clarify the clinicopathophysiology of splenic vein occlusion due to pancreatic disease from hemodynamic points of view. We reviewed the angiographic findings and medical records of 82 patients who had pancreatitis, pancreatic cyst or pancreatic cancer in the pancreatic body and tail. According to the site of occlusion in 16 patients with complete splenic vein occlusion, this entity may be divided into two categories: Type A, an occlusion close to the spleen in which short-gastric system seems to be major collateral, and Type B, an occlusion distant from splenic hilum in which gastroepiploic system becomes prominent as collateral. As compared to 7 patients with incomplete splenic vein occlusion, gastric varices and splenomegaly were frequently observed with the patients having complete occlusion. Among these 16 patients, splenic arterial occlusion was superimposed in 3 patients with pancreatic cancer in whom gastric varices were not detected. Thus, clinical features of this entity must be carefully assessed according to the nature of the underlying disease. Based on these observations, three consecutive phases: Phase 1 Insiduous or latent phase, Phase 2 Collateral developing phase, Phase 3 Vanishing phase may be distinguished for splenic vein occlusion secondary to pancreatic disease.

[Treatment of thoracic empyema in recent 6 years; analysis of 944 cases in Japan]

944 cases of thoracic empyema were treated surgically in a 6-year period (from 1981 through 1986) in 37 institutions under supervision of Ryoken. Preoperative backgrounds, operative modes and surgical results are evaluated. Preoperative backgrounds are as follows; Acute cases comprised only 5.5% of the total. Primary cases outnumbered postoperative ones, the former occupying 65.8% of the total. Fistulous empyema comprised 68.6% of the total. Extension of the empyema; total empyema 56.0%, partial empyema 44.0%. Concerning respiratory reserve, those with FEV1/VCpr (to be denominated RI) less than 40 comprised 44.3% of the total. As to bacteriological findings; positive 49.9%, negative 40.0%, unknown 10.1%. Surgical modes; Pleuroresection 20.8%, decortication 22.4%, space-reducing 28.6%, air-plombage 9.7%, open drainage 6.8%, closed drainage 4.3%, others 7.4%. Overall results; success 83.8%, unsuccess 11.5%, death 4.7%. Those with positive microorganisms and RI less than 40 fared most poorly; success 73.2%, unsuccess 19.7% death 7.1%. Those with negative microorganisms and RI more than 41 fared most well; success 97.9%, unsuccess 1.5%, death 0.5%. Success rate with regard to surgical modes; air-plombage 95.7%, decortication 95.3% pleuroresection 92.6%, space-reducing 80.0%, closed drainage 68.3%, open drainage 29.7%.

Hemodynamic study of occlusion of the splenic vein caused by carcinoma of the pancreas

The most common cause of occlusion of the splenic vein is pancreatic disease, such as pancreatitis or carcinoma of the pancreas. As compared with benign causes, carcinoma of the pancreatic body or tail may readily involve not only the splenic vein, but also, eventually, the splenic artery. Therefore, the clinical features of occlusion of the splenic vein may be profoundly altered according to the nature of the underlying causes. In an attempt to clarify the pathophysiologic findings and hemodynamic mechanism of occlusion of the splenic vein associated with carcinoma of the pancreas, three patient reports were selected from our past experience. Upon analyzing the clinical course of these patients, three consecutive phases may be distinguished. Phase 1 is the insidious or latent phase represented by Patient No. 1. The splenic vein is partially occluded and gastric varices or splenomegaly has not developed. Phase 2, the collateral developing phase, is represented by Patient No. 2. The splenic vein is completely occluded while the splenic artery is patent, resulting in marked gastric varices and splenomegaly. Phase 3 is the vanishing phase and is represented by Patient No. 3. The occlusion of the splenic artery is superimposed on the occlusion of the splenic vein, causing gastric varices to vanish and the enlarged spleen to shrink.

[Multiple primary cancers in surgically resected lung cancer patients]

Among 337 cases of surgically resected lung cancer from April 1977 to March 1984, there were 24 cases (7.12%) of multiple primary cancers including 22 cases of double cancer and one case each of triple and quadruple cancer. They consisted of 17 males and 7 females and the patient age at the time of the lung resection ranged from 32 to 81 years old (average: 67.4). In double cancer cases, the most common site of the other primary cancer was the lung (9 cases), followed by the stomach (5 cases), the colon (4 cases), the pancreas (2 cases), and there was one case each of the salivary gland and the skin. The cases of triple and quadruple cancer involved multiple primary lung cancer associated with mammary and esophageal cancer, respectively. There were 14 synchronous and 8 metachronous cases. The histology of lung cancer in 13 cases of double cancer was adenocarcinoma in 6, squamous cell carcinoma in 2, large cell carcinoma in 3, small cell carcinoma in 1, and adenosquamous cell carcinoma in 1. The histology of 11 cases of double or triple primary lung cancers was squamous cell carcinoma in 17, adenocarcinoma in 5, and large cell carcinoma in 1. In 24 cases 19 lobectomies, 4 pneumonectomies and one partial resection of the lung was performed for the first primary lung cancer. All cancer lesions of other organs apart from the lung were also surgically resected.(ABSTRACT TRUNCATED AT 250 WORDS)

Acrosome reaction of cock spermatozoa incubated with the perivitelline layer of the hen's ovum

A small membranous sheet of the perivitelline layer (PL) isolated from freshly ovulated ova was incubated with cock spermatozoa, and morphological changes of PL and percentage of spermatozoa lacking acrosomes were observed during incubation. The sheet of PL gradually became fragmented as incubation proceeded; fragments were dispersed into a suspension 70 min after the beginning of incubation. To analyze the acrosome reaction induced by the PL, washed or diluted spermatozoa were incubated with or without a PL suspension at 39 C or 41 C. In spermatozoa incubated with the PL suspension, the percentage of spermatozoa lacking acrosomal caps was significantly greater than in controls (without PL). Based on these results, it is suggested that the PL promotes the acrosome reaction by which enzymes contained in the acrosome are released to dissolve the PL.

Extensive skeletal involvement detected by gallium-67 citrate in a patient with multiple myeloma

Extensive skeletal involvement of multiple myeloma was detected by Ga-67 citrate imaging while searching for infectious foci. The case was unique in that a radiographic skeletal survey showed typical lytic lesions only in the skull, and extensive myeloma involvement in the skeletal system was an incidental finding. A high tumor cell burden was presumed to be present, which led to a rapid and fulminant clinical course in this patient.

Effect on turkey spermatozoa of a frothy fluid derived from the cloaca of a male turkey

The influence on turkey spermatozoa of a frothy fluid derived from the cloacal region of a male turkey was investigated. The frothy fluid was collected from the turkey tom during mounting, and semen for the experiment was obtained from the ductus deferens removed after necropsy. Spermatozoa diluted with frothy fluid were examined for motility, viability, and fertilizing capacity and compared with semen diluted with phosphate buffer or undiluted ductal semen. The life-span of spermatozoa suspended in frothy fluid was slightly prolonged during in vitro storage as compared with the undiluted semen or the semen diluted with phosphate buffer; however, a rapid increase of the number of deformed spermatozoa during storage was observed in the semen diluted with frothy fluid. The fertilizing ability of spermatozoa was not influenced by the dilution with frothy fluid when the diluted spermatozoa were inseminated intravaginally immediately after the dilution. On the contrary, when spermatozoa suspended in frothy fluid were preserved at 0 C for 24 h, their fertilizing capacity decreased drastically, probably due to the increased number of abnormal spermatozoa during in vitro preservation.