Dependence of collateral and small airway resistances of CO2 and volume in dog lobes

We examined the hypothesis that collateral channels were identical within small airways and ducts, therefore both should respond similarly to chemical and mechanical stresses. A double lumen catheter was wedged into a segmental bronchus of the dog and humidified air or 10% CO2 in air (Vs) flowed at a segmental bronchial pressure (Pb) of 2 cm H2O. A small circular area about 1 cm diameter was peeled from the wedged segment and covered with a capsule glued to the surrounding pleura for measuring either a small airway flow (Vsaw) or capsule pressure (Pcap). Collateral resistance (Rcoll) and small airway resistance (Rsaw) were calculated as Rcoll = Pb/(Vs-Vsaw), Rsaw = (Pb-Pcap)/Vsaw, respectively. Hypocapnia (air) resulted in increases in Rcoll and Rsaw, while hypercapnia (10% CO2) generally had the opposite effect. Gcoll and Gsaw both increased linearly with lung volume (VL). The pattern of the responses of Rsaw closely paralleled those of Rcoll to local hypercapnia and hypocapnia, and to changing VL, implying that the major sites of resistance along collateral channels and along the airways are functionally and structurally similar.

Effects of diet high in medium-chain triglyceride on plasma ketone, glucose, and insulin concentrations in enterectomized and normal rats

The effects of dietary medium-chain triglyceride (MCT) on the concentration of plasma ketone bodies in enterectomized and normal rats were examined, together with the effects on plasma glucose, plasma immuno-reactive insulin, and liver function. Four groups of enterectomized rats and four groups of normal rats were fed experimental diets containing 0, 6, 11, or 21% of MCT by weight for 6 days. All animals including normal rats received meal-feeding for 3 h once a day. On day 3, concentration of plasma ketone bodies in enterectomized rats increased dose-dependently with dietary MCT and the level was higher than that in normal rats. However, all the values in enterectomized rats never exceeded 2 mM, the maximum physiological concentration. In contrast, plasma glucose in the enterectomized rats showed a tendency to decrease more clearly and dose-dependently with dietary MCT, followed by a marked increase of insulin secretion compared with those in normal rats. On the final day, no significant differences in the results of liver function tests were observed among these groups. These results indicate that the MCT-induced ketosis was within an acceptable range, and dietary MCT is useful for the suppression of increase in plasma glucose following a surgical operation without any disadvantageous effects on liver function.

Acute promyelocytic leukemia with t(15;17) abnormality after chemotherapy containing etoposide for Langerhans cell histiocytosis

BACKGROUND

Epipodophyllotoxins, etoposide and teniposide, have been shown to be implicated in the development, of acute myelogenous leukemia in patients treated for solid tumors or acute lymphoblastic leukemia. Etoposide has been shown to be an effective agent against Langerhans cell histiocytosis (LCH) and has gained wider use recently for first-line and salvage chemotherapy in cases of systemic LCH.

METHODS

The authors report two patients with secondary acute promyelocytic leukemia (APL) with a t(15;17) abnormality after chemotherapy that included etoposide for the treatment of LCH.

RESULTS

Patient 1, a 6-year-old girl, had APL develop 11 months after cessation of therapy that included vinblastine, prednisolone, and etoposide (9600 mg/m2 in total dose) for LCH. Patient 2, a 3-year-old girl, had APL develop 9 months after cessation of therapy that included vincristine, methotrexate, prednisolone, cyclophosphamide (10,800 mg/m2), and etoposide (4800 mg/m2) for LCH.

CONCLUSIONS

The authors have experience with four patients treated with etoposide for LCH and suggest that there is a predisposition to secondary APL with t(15;17) for patients with LCH treated with etoposide. The authors warn against the imprudent use of etoposide as a first-line therapy for LCH.

Urea rebound and residual renal function in the calculation of Kt/V and protein catabolic rate

Kt/V-urea and protein catabolic rate (PCR) are used for dialysis prescription and evaluation of protein intake of patients on regular dialysis treatment. The study was undertaken to determine the implication of urea rebound and residual renal function (RRF) on the calculation of Kt/V-urea and PCR for 61 patients. Kt/V-urea and PCR were calculated, implementing or not urea rebound at one hour after the end of dialysis session. Urea and creatinine rebound rate in patients without RRF was significantly higher than in patients with RRF (P < 0.05). In patients without RRF, creatinine generation rate and Kt/V-urea calculated without rebound were significantly higher than calculated with rebound (P < 0.001). On the contrary, calculation of urea generation and PCR is not affected by these parameters. It is concluded that: (1) Rebound rate magnitude of urea and creatinine is dependent on solute molecular weight, RRF and probably on dialysis duration, whereas rebound rate magnitude of phosphorus is not affected, and (2) Rebound should be taken into account in the calculation of Kt/V-urea and creatinine generation rate in patients without RRF, otherwise, they would be overestimated.

Responsiveness of and interactions between airways and tissue in guinea pigs during induced constriction

Mechanical interdependence between airways and tissues can modify the magnitude of induced bronchoconstriction. We questioned whether the guinea pig, an animal with abundant airway smooth muscle, would differ from other species in the relative responsiveness of and interactions between airways and tissues. Therefore we induced constriction with aerosolized methacholine (MCh) and partitioned responses into airway and tissue components. We measured tracheal and alveolar pressures using alveolar capsules in open-chest guinea pigs (n = 9) during mechanical ventilation [frequency = 1 Hz, tidal volume = 6 ml/kg, positive end-expiratory pressure (PEEP) = 5 cmH2O] and calculated the resistance of lung (RL), tissue (Rti), and airway (Raw) before and after administration of aerosols of MCh in progressively doubling concentrations (0.063-16 mg/ml). In separate animals (n = 10), measurements were made at 3-13 cmH2O PEEP. After aerosols of saline and MCh (0.125-32 mg/ml), measurements were repeated at 3, 7, and 11 cmH2O PEEP. At submaximal levels of constriction, the airways and lung tissues demonstrated similar responsiveness. Increasing PEEP increased RL and Rti and decreased Raw under baseline conditions. At low concentrations of MCh, increasing PEEP increased RL but decreased RL at the highest concentration. Increases in PEEP significantly increased Rti at all concentrations of MCh but decreased Raw only at 8 mg/ml of MCh. These observations demonstrate that, in guinea pigs, during submaximal constriction, airways and tissues behave similarly; moreover, airway-parenchymal interdependence is important in determining the level of bronchoconstriction.

Kinetics of technetium-labeled heparin in hemodialyzed patients

Technetium-labeled heparin kinetics studies were undertaken in 12 hemodialyzed patients, where heparin was used over a long term (1 to 10 years) for anticoagulation of the extracorporeal circuit. The 99mTc-heparin (99mTc VECTOSCINT, Solabco Nuclear, Coutras, France) used has a 10 mCi activity and a labeling efficiency of more than 95%. Two healthy subjects served as control. After an i.v. bolus of 2 ml 99mTc-heparin, corresponding to 170 +/- 10 IU, radioactivity of kidney, liver, knee and shoulder was recorded with a gamma camera at t1-h, t3-h and t6-h during 120, 152 and 215 s, respectively. Radioactivity recorded was computerized, giving quantitative data for comparison. In hemodialyzed patients, accumulation of radioactivity (mean +/- SEM 10(6) x activity count) was significantly higher at the knee (11.3 +/- 1.1 vs. 4.9 +/- 0.4; p < 0.05; 13.4 +/- 1.1 vs. 5.7 +/- 0.7; < 0.02; and 14.7 +/- 0.8 vs. 5.3 +/- 0.6; < 0.001), and on the shoulder (17.3 +/- 1.1 vs. 10.7 +/- 1.4; p < 0.05; 19.9 +/- 1.0 vs. 10.9 +/- 1.7; < 0.01; 20.8 +/- 1.1 vs. 10.1 +/- 0.9; < 0.01) at t1-h, t3-h and t6-h, respectively, than in control subjects at the same areas. Although direct evidence is not in hand, accumulation of heparin in bone tissue due to renal excretion failure could play a role in mineral metabolism resulting in osteopenia in hemodialyzed patients.

Oral 1,25(OH)2D3 pulse therapy for the treatment of secondary hyperparathyroidism

We examined the effect of oral 1,25(OH)2D3 pulse therapy in hemodialyzed patients with secondary hyperparthyroidism (2 degrees HPT). Prescription of 6.0 micrograms 1,25(OH)2D3 once a week combined with calcium carbonate as a phosphate binder during the last 5 days a week for 12 weeks resulted in improvement of mild to moderate 2 degrees HPT despite no significant differences in serum total calcium and phosphate concentration. In addition, the effect was greater in cases with mild 2 degrees HPT. A single administration of 6 micrograms 1,25(OH)2D3 reduced the parathyroid hormone concentration in patients with mild 2 degrees HPT or with a short duration of hemodialysis. Tmax of the serum 1,25(OH)2D3 after single administration of 6.0 micrograms 1,25(OH)2D3 was individually different (range, 0.4-20.9 hrs). It is recommended that early employment of oral 1,25(OH)2D3 pulse therapy be undertaken once a week combined with prescription of calcium salt as a phosphate binder during the last 5 days a week for the treatment of 2 degrees HPT refractory to conventional therapy, since there is no risk of aluminum accumulation with satisfactory control of the serum total calcium and phosphate concentration.

Endopeptidase activity of cathepsin C, dipeptidyl aminopeptidase I, from bovine spleen

By employing various synthetic substrates, as well as soluble denatured protein substrate (TAP-lysozyme) and its derivatives, endopeptidase activity of cathepsin C, dipeptidyl aminopeptidase I [EC 3.4.14.1], from bovine spleen was investigated. Cathepsin C efficiently degraded Z-Phe-Arg-MCA, Pro-Phe-Arg-MCA, and Suc-Leu-Leu-Val-Tyr-MCA. This endopeptidase activity required sulfhydryl reagents and halide ions, as in the case of the dipeptidyl aminopeptidase (DAP) activity. We confirmed that this endopeptidase activity is due to cathepsin C itself based on the results on gel-filtration and anion-exchange chromatographies, comparative studies of the inhibitory effects of leupeptin and E-64 on this activity and those of cathepsins B and L, and further the competitive inhibitions by mutual substrates for the DAP and endopeptidase activities of cathepsin C. We also found that cathepsin C endopeptidase activity towards TAP-lysozyme and its N-alpha-acetylated tryptic peptides showed marked dependence on sulfhydryl reagents and chloride ion. Thus, we concluded that cathepsin C has endopeptidase activity as well as DAP activity. The binding energy between the enzyme and the amino acid side chains of the substrate may be as important for the endopeptidase activity as is the electrostatic interaction between the enzyme and the free alpha-amino group of the substrate for the DAP activity.

A case complicated with SLE during maintenance hemodialysis

A 40-year-old woman suffered from toxemia of pregnancy in 1977 and was admitted to hospital. Thereafter, she developed nephrotic syndrome, underwent a renal biopsy, and a diagnosis of membranoproliferative glomerulonephritis (MPGN) was made. She received steroid therapy, immunosuppressive drug and anticoagulant therapy, and recovered sufficiently to be discharged from hospital in April, 1979. During subsequent ambulatory treatment at our outpatient department, her renal function deteriorated gradually, and maintenance hemodialysis was started from June, 1990. In July, 1991, she was admitted to our hospital with pleurisy and pericarditis. There was no improvement despite antibiotic treatments. Laboratory data revealed leukopenia and lymphopenia. Under suspicion of systemic lupus erythematosus (SLE), relevant tests were carried out. Immunological abnormalities such as positive LE cells and the presence of various autoantibodies, together with clinical signs of hypersensitivity to sunlight, stomatitis and serositis, satisfied the diagnostic criteria of the ARA and a diagnosis of SLE was made. This case did not exhibit any clinical or serological abnormalities except for the renal disorder for a 10-year period after the histological diagnosis of MPGN, but was eventually diagnosed as SLE as a result of the manifestation of SLE symptoms for the first time after one year of maintenance hemodialysis. Immunological abnormalities and SLE during maintenance hemodialysis are discussed in relation to other reports.

The most suitable calculation of Kt/V-urea: Kt/V = ln(Ci/Cf)

Although various simplified calculation formulae of Kt/V-urea based on urea kinetic modeling have been reported, all the formulae include errors such as post-dialysis urea rebound and urea generation during a dialysis session. In the present study, in order to calculate the precise Kt/V-urea, a formula of Kt/V-urea, taking into account post-dialysis plasma urea rebound and urea generation during a dialysis session (Kt/V-P) was proposed, and compared to other formulae already published, in 49 dialysis patients without residual renal function (26 M and 23 F; mean age, 65 +/- 2 years; mean dialysis duration, 70 +/- 7 mos). The precise post-dialysis plasma urea concentration was significantly higher than the actually measured post-dialysis plasma urea concentration by approximately 12%, and Kt/V-P corresponded to Kt/V-urea = ln(Ci/Cf) with the best correlation in the formulae utilized in the present study, around 1 of Kt/V-urea, which is clinically the most important range. It is concluded that Kt/V-urea = ln(Ci/Cf) is the most suitable formula for the calculation of Kt/V-urea, when post-dialysis plasma urea rebound and urea generation during a dialysis session are taken into account.

How long can continuous ambulatory peritoneal dialysis be continued?

We investigated how long continuous ambulatory peritoneal dialysis (CAPD) could be continued in the face of peritoneal sclerosis. 15 CAPD patients with no experience of peritonitis were selected and the time limitation for CAPD was examined retrospectively, based on the dialysate osmolality, serum creatinine concentration, etc.. The values for the dialysate osmolality and serum creatinine concentration increased gradually with the duration of CAPD and were significantly increased from 6 months. 5 patients whose serum creatinine concentration during the first 6 months after initiation of CAPD increased more than 5 mg/dl, could not continue CAPD for more than 24 months because of the appearance of peritoneal membrane failure. When the time limitation for CAPD was assessed in 10 stable patients, close relationships between the mean dialysate osmolality and duration of CAPD (Y = 0.52X + 351.25, r = 0.83, P < 0.01), and between the mean serum creatinine concentration and duration of CAPD (Y = 0.18X + 6.84, r = 0.95, P < 0.001) were recognized. If the practical limitation for CAPD was set at 400 mOsm/l in terms of the dialysate osmolality or 20 mg/dl in terms of serum creatinine concentration, its value became 94.1 months or 73.1 months, respectively. It is concluded that the time limitation for CAPD can be expected to be approximately 6 to 8 years in stable CAPD patients, and we need to resolve CAPD-induced problems involving the peritoneal membrane in order to continue CAPD for more than 10 years.

Partitioning of pulmonary responses to inhaled methacholine in subjects with asymptomatic asthma

To partition the central and peripheral airway resistance, a catheter-tip micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a bronchus with a 3 mm inner diameter in 10 patients with asymptomatic asthma. We simultaneously measured mouth flow, transpulmonary pressure (PL) and intra-airway lateral pressure during tidal breathing. Total pulmonary resistance (RL) was calculated from PL and mouth flow, and central airway resistance (RC) was calculated from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (Rp) was obtained by subtraction of RC from RL. Therefore, our measurement of Rp included lung tissue resistance. The technique permitted identification of the site of changes in airway resistance. The baseline values of resistances were 2.3 +/- 0.2 cm H2O/L/s in RL, 1.5 +/- 0.1 cm H2O/L/s in RC, and 0.8 +/- 0.1 cm H2O/L/s in Rp, respectively. To determine the site of airway hyperresponsiveness, dose-response curves of central, peripheral, and total airways to inhaled methacholine were separately constructed. Bronchial responsiveness was evaluated by a log methacholine unit requiring a 35% decrease (PC35) and a 50% decrease (PC50) in pulmonary conductance (a reciprocal of RL). We calculated the increase of resistances in total (delta RL), central (delta RC), and peripheral (delta Rp) airways from the baseline values at either PC35 or PC50.(ABSTRACT TRUNCATED AT 250 WORDS)

Effective site of bronchodilation by beta-adrenergic and anticholinergic agents in patients with chronic obstructive pulmonary disease: direct measurement of intrabronchial pressure with a new catheter

To study the effective site of bronchodilators in patients with chronic obstructive pulmonary disease (COPD), a catheter tip micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a bronchus, 3 mm inner diameter, in 14 patients with COPD. We simultaneously measured mouth flow, transpulmonary pressure (PL) and intra-airway lateral pressure during quiet tidal breathing. Total pulmonary resistance (RL) was calculated from PL and mouth flow, and central airway resistance (RC) was calculated from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (RP) was obtained by the subtraction of RC from RL. This technique permitted identification of the site of changes in airway resistance. Atropine sulfate (5 mg/ml) was continuously inhaled during tidal breathing for 1 min by seven patients (Group A), and the other seven patients (Group B) inhaled fenoterol (1 mg/ml) for 1 min. The doses that were actually delivered were 0.75 mg for atropine sulfate and 0.15 mg for fenoterol. The baseline resistances of RC and RP were 3.9 +/- 0.8 and 3.7 +/- 0.6 cm H2O/L/s in Group A, and 4.3 +/- 0.5 and 3.5 +/- 0.4 cm H2O/L/s in Group B, respectively. Both atropine sulfate and fenoterol significantly decreased RL by an average of 2.4 and 2.6 cm H2O/L/s, and there was no significant difference between them (p greater than 0.20). The percentage decrease in resistance from the baseline values by fenoterol did not differ significantly between RC and RP (p greater than 0.20). However, atropine sulfate significantly decreased RC more than RP.(ABSTRACT TRUNCATED AT 250 WORDS)

Site of airway obstruction in pulmonary disease: direct measurement of intrabronchial pressure

To partition the central and peripheral airway resistance in awake humans, a catheter-tipped micromanometer sensing lateral pressure of the airway was wedged into the right lower lobe of a 3-mm-ID bronchus in 5 normal subjects, 7 patients with chronic bronchitis, 8 patients with emphysema, and 20 patients with bronchial asthma. We simultaneously measured mouth flow, transpulmonary pressure, and intra-airway lateral pressure during quiet tidal breathing. Total pulmonary resistance (RL) was calculated from transpulmonary pressure and mouth flow and central airway resistance (Rc) from intra-airway lateral pressure and mouth flow. Peripheral airway resistance (Rp) was obtained by the subtraction of Rc from RL. The technique permitted identification of the site of airway resistance changes. In normal subjects, RL was 3.2 +/- 0.2 (SE) cmH2O.l-1.s and the ratio of Rp to RL was 0.24 during inspiration. Patients with bronchial asthma without airflow obstruction showed values of Rc and Rp similar to those of normal subjects. Although Rc showed a tendency to increase, only Rp significantly increased in those patients with bronchial asthma with airflow obstruction and patients with chronic bronchitis and emphysema. The ratio of Rp to RL significantly increased in three groups of patients with airflow obstruction (P less than 0.01). These observations suggest that peripheral airways are the predominant site of airflow obstruction, irrespective of the different pathogenesis of chronic airflow obstruction.

[Methylguanidine kinetics during oral active vitamin D pulse therapy for secondary hyperparathyroidism]

Active vitamin D (VD) metabolite preparations have been used in the management of secondary hyperparathyroidism (2 degrees HPT) due to impaired calcium and phosphorus metabolism and can allegedly be expected to prevent, to some extent, the progression of this pathological condition. Unfortunately, however, it is not uncommon for us in routine clinical practice to find 2 degrees HPT of moderate or greater severity embarrassingly unamenable to treatment with these VD preparations in ordinary oral therapeutic doses. Recent studies have gradually reported that intravenous administration of 1,25-(OH)2D3 and oral active VD pulse therapy has been therapeutic approach to 2 degrees HPT. Methylguanidine (MG) among other GCs, its precursor is already identified as creatinine and activated oxygen as well PTH and VD are known to participate in the process leading to its formation. In the present study, we administered oral 1,25-(OH)2D3 pulse therapy to patients with chronic renal failure for the treatment of 2 degrees HPT in an attempt to assess the effectiveness of this therapeutic regimen and to explore the clinical effect of MG on responsiveness to the therapy. The purpose of this paper is to present the results thus obtained. Oral 1,25-(OH)2D3 pulse therapy (6 micrograms once a week) was administered to 21 hemodialysis patients with for 12 weeks. Of these 21, 10 patients responded to the therapy with a more than 20% reduction in serum (PTH): (responsive group), whereas the remaining 11 did not (resistant group). Pretreatment serum PTH levels were significantly higher in the latter group than the former.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of parameters for adequate dialysis therapy: (2). Comparison between parameters according to UKM and other laboratory data

Urea kinetic modeling (UKM) is often regarded as the best method for assessing the dialysis adequacy and consequently for the prescription of treatment time. However, other parameters are involved in the monitoring of end stage renal disease (ESRD) patients. Kt/V-urea and protein catabolic rate (pcr) were evaluated in 53 ESRD patients (25 males and 28 females; mean age, 60 +/- 2 years old; mean duration, 80 +/- 11 months), twice at an interval of 4 months, and pre-dialysis concentration of (pre-DC) plasma potassium, bicarbonate, calcium and phosphate were measured. The pre-dialysis systolic blood pressure and hematocrit were also recorded. The numbers of patients who were within the optimal range of Kt/V-urea and pcr recommended by Gotch and Sargent were 36 (67.9%) and 39 (73.6%), respectively, at the first control period, and 39 (73.6%) and 44 (83.0%) at the second control period. However, only about 50% of the patients were within the optimal range of pre-DC plasma calcium, phosphate and bicarbonate. Furthermore, very few patients fulfilled the conditions for all the parameters. It is concluded that (1) UKM is required to describe the domain of dialysis prescription, and (2) other parameters which are not dependent so much on dialysis should be taken into account for assessing the adequacy of dialysis.

Phosphate removal during hemodialysis, hemodiafiltration, and hemofiltration. A reappraisal

Kinetics of phosphate removal, based on hourly collection of used dialysate or filtrate and hourly changes of phosphate plasma concentration, were studied in hemodialysis (QB 300; QD 500 ml/min), hemodiafiltration (QB 300; QD 500; QSF 25 ml/min), and hemofiltration (QB 250; QSF 70 ml/min) for six 5-hour sessions in each mode of therapy. Whatever the pretreatment phosphate concentration (1.5-2.0 mmol/L range), and whatever the treatment modality used, final plasma phosphate concentration was in the narrow range of 0.8-0.9 mmol/L, and about 50% of the total mass transfer occurred during the first 2 hours. At the third hour, a steady state is reached, suggesting that removal of phosphate is limited by the rate of phosphate transfer from body compartments to extracellular fluid, which was on the average about 362 mumol/kg.hr. Consequently, total phosphate mass transfer accounts only for 20 to 28 mmol per session. Control of pretreatment phosphatemia in the range of 1.5 to 2.0 mmol/L depends on daily phosphate binder prescription, calcitriol supplementation, and control of metabolic acidosis; one cannot rely on intermittent phosphate removal during the dialysis session.

Effective site of bronchodilation by antiasthma drugs in subjects with asthma

We studied the effective sites of airway response to atropine and fenoterol aerosols and to the intravenous injection of aminophylline in patients with stable and spontaneous asthma, by the simultaneous assessment of respiratory resistance (Rrs) and anatomic dead space (VD). Central airway response was determined by VD, and overall response was determined by Rrs. Peripheral airway response was inferred from Rrs when the change in VD was slight. Atropine (4 mg/ml) or fenoterol (0.4 mg/ml) was continuously inhaled during tidal breathing for 5 minutes. Inhalation of both atropine and fenoterol increased Grs (reciprocal of Rrs) (p less than 0.01) with a simultaneous increase in VD (p less than 0.01) in the patients with stable and spontaneous asthma. Fenoterol increased Grs more than did atropine at an equivalent increase in VD in patients with spontaneous asthma (p less than 0.05). Intravenous injection of aminophylline (250 mg) had no effect on either Grs or VD in patients with stable asthma, but it significantly increased Grs (p less than 0.01) without change in VD in patients with spontaneous asthma. These results suggest that the predominant sites of bronchodilation induced by inhaled atropine are the central airways, that those sites induced by intravenous injection of aminophylline are the peripheral airways, and that inhaled fenoterol dilates both the central and peripheral airways in subjects with asthma. Differences among clinically used bronchodilators on the effective sites may be considered in the treatment of bronchial asthma.

[No rearrangement of the breakpoint cluster region in two juvenile chronic myeloid leukemia]

We performed cytogenetic studies and breakpoint cluster region (bcr) rearrangement analysis in two cases of juvenile chronic myeloid leukemia (JCML) which is special type of chronic myeloid leukemia (CML). Case 1 (8-month-old male) and case 2 (3-month-old female) showed clinical and hematologic manifestations similar to CML. Each of case 1 and 2 had normal karyotype and no bcr rearrangement. These findings suggest that JCML is a different heterogeneous disorder from that of adult CML.

Pharmacokinetics and optimum dose of disopyramide in patients with chronic renal failure

The pharmacokinetics and optimum dose for maintenance of disopyramide (DP) which is effective against arrhythmia were studied in patients with chronic renal failure (CRF, n = 10), who had a creatinine clearance (Ccr) less than 30 ml/min. The plasma concentrations (PC) of DP and mono-isopropyl-disopyramide (MDP) an active metabolite of DP, were measured by high performance liquid chromatography. Samples from patients and controls were obtained at 0, 1, 2, 3, 4, 6, 8, 12, 24, 33, and 48 hr after oral administration (OA) of 100 mg DP. The pharmacokinetic parameters were calculated using a two-compartment model. In CRF, the plasma half life (T 1/2) of DP was 5.25 to 22.42 hr (average is 12.45 hr) and that of MDP was 5.09 to 131.66 hr (average is 16.9 hr). In normal controls, the T 1/2 of DP was 6.05 hr, but that of MDP could not be determined the available sensitivity of measurement. T max was 3.11 hr at the total PC of DP and MDP, and C max was 2.48 g/ml on average. In conclusion, the present study revealed that: (1) the PC of a mixture of DP and MDP should rise following OA of DP every 8 or 12 hr in CRF; (2) it is necessary therefore to monitor the accumulation of MDP after rolling OA of DP; and (3) OA of DP every 24 hr can maintain an effective PC.

The analysis of the defense mechanism against indigenous bacterial translocation in X-irradiated mice

The defense mechanism against indigenous bacterial translocation was studied using a model of endogenous infection in X-irradiated mice. All mice irradiated with 9 Gy died from day 8 to day 15 after irradiation. The death of mice was observed in parallel with the appearance of bacteria from day 7 in various organs, and the causative agent was identified to be Escherichia coli, an indigenous bacterium translocating from the intestine. Decrease in the number of blood leukocytes, peritoneal cells and lymphocytes in Peyer's patches or mesenteric lymph nodes was observed as early as 1 day after irradiation with 6 or 9 Gy. The mitogenic response of lymphocytes from various lymphoid tissues was severely affected as well. The impairment of these parameters for host defense reached the peak 3 days after irradiation and there was no recovery. However, in vivo bactericidal activity of Kupffer cells in mice irradiated with 9 Gy was maintained in a normal level for a longer period. It was suggested that Kupffer cells play an important role in the defense against indigenous bacteria translocating from the intestine in mice.

Nicotine improves cognitive disturbance in rodents fed with a choline-deficient diet

The effect of nicotine on learning disturbances was tested in rats. Rats were fed either a choline-enriched or a choline-deficient diet. Concentration of acetylcholine in the whole brain was significantly lower in rats fed with choline-deficient diet than rats fed with choline-enriched diet. Passive avoidance learning shows that rats on a choline-deficient diet showed significantly impaired learning compared to rats on a choline-enriched diet. Nicotine (0.04 mg/kg) administered intraperitoneally significantly potentiated learning in rats on a choline-deficient diet, as well as in rats on a choline-enriched diet. We, therefore, suggest that nicotine may potentiate learning in an acetylcholine-deprived brain.

Prolonged hypoxemia after 10 min walking exercise in aged patients with chronic obstructive pulmonary disease

Although the behavior and factors of exercise tolerance have been studied during exercise in patients with chronic obstructive pulmonary disease (COPD), little attention has been paid to the after-effects of such activity. Arterial oxygen saturation (SaO2) was monitored during and after a 10 min walking exercise in aged patients with COPD. Neither baseline SaO2 nor mean SaO2 during exercise correlated to the 10 min walking distance. However, the recovery time of SaO2 to the baseline value shows significant correlation to the 10 min walking distance. Careful attention should be paid to prolonged hypoxemia after exercise in severe cases of COPD.

Permanent brain damage possibly caused by theophylline in two elderly patients with airway obstruction

Two aged patients with bronchial asthma and chronic obstructive pulmonary disease who suffered convulsions that resulted in permanent brain damage during treatment with the recommended therapeutic dose of theophylline are presented here. A dose or concentration of theophylline lower than the recommended one should be considered in the treatment of some aged patients with pulmonary obstructive disease.

Ozone increases susceptibility to antigen inhalation in allergic dogs

To determine whether O3 exposure increased airway responsiveness to antigen inhalation, we studied airway responsiveness to acetylcholine (ACh) and Ascaris suum antigen (AA) before and after O3 in dogs both sensitive and insensitive to AA. Airway responsiveness was assessed by determining the provocative concentration of ACh and AA aerosols that increased respiratory resistance (Rrs) to twice the base-line value. O3 (3 parts per million) increased airway responsiveness to ACh in dogs both sensitive and insensitive to AA, and it significantly decreased the ACh provocation concentration from 0.541 +/- 0.095 to 0.102 +/- 0.047 (SE) mg/ml (P less than 0.01; n = 10). AA aerosols, even at the highest concentration in combination with O3, did not increase Rrs in dogs insensitive to AA. However, O3 increased airway responsiveness to AA in AA-sensitive dogs and significantly decreased log AA provocation concentration from 2.34 +/- 0.22 to 0.50 +/- 0.17 (SE) log protein nitrogen units/ml (P less than 0.01; n = 7). O3-induced hyperresponsiveness to ACh returned to the base-line level within 2 wk, but hyperresponsiveness to AA continued for greater than 2 wk. The plasma histamine concentration after AA challenge was significantly higher after than before O3 (P less than 0.01). Intravenous infusion of OKY-046 (100 micrograms.kg-1.min-1), an inhibitor of thromboxane synthesis, inhibited the O3-induced increase in responsiveness to ACh, but it had no effects on the O3-induced increase in responsiveness to AA and the increase in the plasma histamine concentration. These results suggest that O3 increases susceptibility to the antigen in sensitized dogs via a different mechanism from that of O3-induced muscarinic hyperresponsiveness.

Pernicious anemia in a patient with hypogammaglobulinemia

A 19-year-old male with pernicious anemia and hypogammaglobulinemia (common variable immunodeficiency: CVID) is reported in comparison with classical pernicious anemia. This case was characterized by an earlier onset of anemia, the absence of autoantibodies to intrinsic factor or gastric parietal cells and involvement of the pyloric antrum as well as the gastric corpus. It is suggested that dysregulation of cellular immunity produces the autoimmune lesion in the gastric mucosa, including the pyloric antrum, in a patient with CVID, and that some of such cases develop pernicious anemia.

[A case of hepatocellular carcinoma associated with chronic renal failure on haemodialysis]

A 36 years old man with chronic renal failure on haemodialysis therapy presented with a hepatic mass which was diagnosed by ultrasonography, and was admitted to our hospital. Computer tomography and hepatic angiography revealed hepatocellular carcinoma of the right anterior superior segment of the liver. His liver function test, alpha-fetoprotein (AFP) and carcinoembryonic antigen levels in the serum were within the normal range. HBs antigen was also negative. Resection of right antero-superior segment was done following transcatheter arterial embolization. The tumor was homogeneous and light yellowish in color, and well demarcated by the capsule. Nontumorous tissue did not show either fibrosis or any inflammatory reaction. In general, hepatocellular carcinoma is associated with a positive HBs antigen and altered liver function. We here report a rare case of hepatocellular carcinoma in a man who was undergoing haemodialysis treatment for chronic renal failure with normal liver function test and negative HBs antigen.

Tracheobronchial mucociliary clearance and alveolar epithelial permeability measured by PET with 18FDG powder

Tracheobronchial mucociliary clearance and alveolar permeability were measured with positron emission tomography using a water-soluble dry aerosol, sodium-N-acetyl-neuraminate tagged with 2-deoxy-2-[18F]fluoro-D-glucose (18FDG powder). Five normal volunteers inhaled 1.5-2.0 mCi of FDG powder by a single deep breath. The distribution of radioactivity, measured by scanning during a period of 120 min, showed that the 18FDG powder deposition progressed from the central airways to the peripheral alveolar areas. In the tracheobronchial system the radioactivity decreased to 24% of the initial deposition at 60 min. In the peripheral alveolar area, where absorption into blood or lymphatic flow crossing the epithelial layer represents a unique mechanism of clearance for water-soluble 18FDG powder, alveolar radioactivity decreased slowly to approximately 70% of the initial deposition at 60 min after inhalation. Positron emission tomography using 18FDG powder provides a regional evaluation of both mucociliary transport in the tracheobronchial system and epithelial permeability in the alveolar area.

Allergic sensitization in elderly patients with chronic obstructive pulmonary disease

To study whether allergic sensitization occurs in elderly patients with chronic pulmonary obstructive disease (COPD), we examined serum IgE and skin test reactivity to allergens in three age-matched groups of normal subjects, and in patients with COPD and bronchial asthma (BA). Serum IgE was significantly higher in patients with COPD and BA than in normal subjects (p less than 0.05), and patients with COPD showed serum IgE levels as high as those of patients with BA. However, the skin test scores were significantly higher in patients with BA than in normal subjects and patients with COPD (p less than 0.05). Neither serum IgE nor skin test score significantly correlated with FEV1%, PaO2, PaCO2 or Brinkman's Index in any group (p greater than 0.20). These results suggest that allergic sensitization occurs in elderly patients with COPD and that symptoms associated with COPD may be partly due to allergic inflammation.

[New methods for measurement of peripheral airway resistance]

We have developed two new methods to evaluate the peripheral resistance of the lung. The first is a method for continuous measurement of the frequency dependence of dynamic compliance (Cdyn, f.d.) and pulmonary resistance (RL) from a single-breath cycle by Fourier-series analysis. In this method, we have found that procaterol my first dilate the central airway and then gradually dilate the peripheral airway in bronchial asthma. The second is a method for the direct measurement of peripheral resistance by the anterograde catheter system using a catheter tip micromanometer. The catheter tip was inserted into the 3 mm diameter small airway anterogradely and intrabronchial pressure was measured simultaneously with transpulmonary pressure and mouth flow. We have found that the values of peripheral resistance in patients with COPD are four to seven times higher than that of normal subjects. These results suggest that the behavior of the peripheral and central airway may differ between patients and that the peripheral airway may be important to examine the pathogenesis of COPD.

Preparation of a fine powder of 2-deoxy-2-[18F]fluoro-D-glucose suitable for inhalation to diagnose lung diseases by means of PET

Fine 2-deoxy-2-[18F]fluoro-D-glucose (18FDG) powder was obtained by adding diethyl ether into a methyl alcohol solution of 18FDG and other sugar as seed. When micronized particles of sodium N-acetyl-neuraminate (Neu5Ac-Na) were used as seed crystals, particles containing 18FDG were obtained and 80% of them were smaller than 10 microns in size. More than 60% of these crystals were 4-6 microns in size. In a preclinical study of forced inhalation in a dog, the 18FDG fine powder was mainly distributed in the trachea. The radioactivity in the trachea then increased once and a gradual decrease followed. The radioactivity was transferred into the blood and radioactivity incorporation into the heart was observed. After a normal volunteer inhaled 18FDG dry powder aerosol, the radioactivity was found in the respiratory tract and the peripheral area of the lung by means of PET. Absorption and in vivo dynamics of the 18FDG were also analysed.

Laryngeal resistance immediately after panting in asthmatic subjects

The panting manoeuvre may be used during the assessment of airway resistance and in asthmatic patients during bronchial provocation testing or spontaneous asthma. To study whether panting opens the larynx in patients with asthma, laryngeal resistance was examined in six patients with stable asthma before and after methacholine induced bronchoconstriction and in another six patients with spontaneous asthma. Subjects were asked to pant and then to hold their breath immediately afterwards. Laryngeal resistance after panting was compared to that during quiet tidal breathing. Change in laryngeal resistance was estimated by a method using low frequency sound and respiratory resistance by forced oscillation at 10 Hz. Mean baseline respiratory resistance during inspiration was 0.245 and 0.470 kPa/l.s before and after methacholine in the patients with stable asthma and 0.480 kPa/l.s in the patients with spontaneous asthma. In the patients with stable asthma mean laryngeal resistance was lower after panting than during the preceding quiet tidal breathing, both before and after methacholine induced bronchoconstriction (by 0.08 before and by 0.065 kPa/l.s after). In contrast, the patients with spontaneous asthma showed an increase in laryngeal resistance after panting of 0.089 kPa/l.s. The magnitude of change in laryngeal resistance after panting was similar to the change in respiratory resistance in the patients with spontaneous asthma and in the patients with stable asthma after methacholine, but was greater than the change in respiratory resistance in the patients with stable asthma before methacholine. These results suggest that panting may cause different effects on the laryngeal aperture in patients with stable and spontaneous asthma.

Endoscopic bronchial polypectomy by high-frequency electric surgery

Although polypectomy by high frequency electric surgery through the use of endoscopy has been widely applied to polypoid lesions in digestive canals, there have been very few reports of the treatment of bronchial lesions with this procedure. Recently, we have been successful in performing polypectomy without any complications using high-frequency electric surgery through a flexible bronchoscope in a patient with a benign bronchial polyp. Bronchial polypectomy by electric surgery has the advantages of preventing bleeding and providing large specimens for histological examination, compared with conventional methods, i.e. for forceps or laser methods.

[Laboratory and clinical studies on cefodizime in the pediatric field]

Laboratory and clinical studies on cefodizime (CDZM, THR-221), a newly developed cephem antibiotic, were done. The results obtained are summarized as follows: 1. Absorption and elimination were examined in a total of 5 cases including a case of 10 mg/kg intravenous drip infusion for 30 minutes, 2 cases of 20 mg/kg rapid intravenous injection and 2 cases of 40 mg/kg drip infusion for 30 minutes. Maximum serum levels were attained immediately after drip infusion or rapid injection. Cmax's were 119.2 micrograms/ml for 10 mg/kg, 374.9 micrograms/ml or 255.7 micrograms/ml for 20 mg/kg, and 321.3 micrograms/ml or 431.8 micrograms/ml for 40 mg/kg. These values were determined using an high performance liquid chromatography (HPLC) method. In general, values using the bioassay were higher than those with the HPLC method. T 1/2 (beta)'s were between 1.74 and 1.93 hours using HPLC, and between 1.77 and 2.24 hours using bioassay. Urinary recovery rates were examined in 3 out of 5 cases. Cumulative urinary recovery rates were 57.9-90.6% with HPLC method and 50.4-88.0% with bioassay in a period of 0-8 hours after administration. 2. Clinical efficacy was evaluated in a total of 22 cases including 14 cases of respiratory tract infections, 5 cases of urinary tract infections and 3 cases of cellulitis. Clinical efficacy rate was 95.2%. Bacteriologically, pathogenic organisms were eradicated in 90.0%. As adverse reactions, 1 angular stomatitis, 1 diarrhea and 1 loose stool were noted. Abnormal laboratory test values detected were 1 case of increased GPT and 1 case of increased GOT and GPT.

Chemotherapy for retinoblastoma

Fourteen patients with retinoblastoma treated with chemotherapy in our hospital were surveyed to study the effects of chemotherapy on retinoblastoma. These patients were compared with those registered in 1980 and 1981 in Japan. In unilateral retinoblastoma limited to the eyeball, there was no significant difference in outcome between the chemotherapy and non-chemotherapy groups. In bilateral retinoblastoma, however, patients treated with chemotherapy within one month after the start of conservative therapy showed a better outcome than those whose chemotherapy was started more than one month after conservative therapy was begun.

[Pharmacokinetic and clinical studies on sulbactam/ampicillin in the pediatric field]

Pharmacokinetic and clinical studies of sulbactam/ampicillin (SBT/ABPC) were conducted and the obtained results are summarized as follows. For pharmacokinetic investigation, SBT/ABPC at 30 or 60 mg/kg was administered by intravenous drip infusion over 30 minutes. The maximum blood concentration was reached just after the completion of the drip infusion in both groups. The mean peak serum concentrations of SBT and ABPC were 22.4 +/- 0.8 micrograms/ml and 32.8 +/- 1.0 micrograms/ml, respectively, in the 30 mg/kg group, and they were 54.2 micrograms/ml and 93.8 micrograms/ml, respectively, in the 60 mg/kg group. The concentrations were dose-related. The mean half-lives of SBT and ABPC following 30 mg/kg SBT/ABPC administration were 0.91 +/- 0.04 hour and 0.90 +/- 0.05 hour, respectively, and those following 60 mg/kg SBT/ABPC were 1.08 hours and 0.84 hour, respectively. The highest urinary concentration occurred 0-2 hours after the 30 minutes drip infusion. Mean urinary excretion rate of SBT and ABPC over 6 hours were 71.4 +/- 2.5% and 54.6 +/- 3.3%, respectively, in the 30 mg/kg group, and they were 80.0% and 63.7%, respectively, in the 60 mg/kg group. In the clinical investigation conducted with a total of 24 patients (15 with respiratory tract infections, 3 with urinary tract infections, 2 with lymphadenitis, and others), SBT/ABPC was found to be excellent in 14 cases, good in 9, fair in 1. The efficacy rate was, therefore, 95.8%. In the bacteriological evaluation, 9 out of 11 clinically isolated strains were eradicated, 1 unchanged and 1 unknown. The elimination rate was 90.0%. Regarding side effects, no abnormal clinical symptoms were observed. As abnormal laboratory values, a slight elevation of GOT was observed.

[Pharmacokinetic and clinical studies of clarithromycin in the pediatric field]

Pharmacokinetic and clinical studies on clarithromycin (TE-031, A-56268), a new macrolide antibiotic, were performed in the pediatric field. 1. Pharmacokinetic investigation We studied serum concentrations and urinary excretions after single oral administration of TE-031 granules and tablets. Doses were 1, 5, 10 and 15 mg/kg body weight in case of granules (10% TE-031) and 150 mg/kg body weight in case of tablets (50 mg TE-031, 3 tablets). As results, Tmax's were 1-2 hours after administration in case of both granules and tablets. Cmax's in cases of granules were 0.29 +/- 0.15 micrograms/ml in 1 mg/kg administration, 2.53 +/- 0.71 micrograms/ml in 5 mg/kg, 4.11 +/- 1.37 micrograms/ml in 10 mg/kg, 6.28 +/- 1.48 micrograms/ml in 15 mg/kg showing a dose dependency. T 1/2's were 1.8-6.5 hours in cases of 1, 5, 10, 15 mg/kg of granules and tablets. T 1/2's became longer with increased doses. Urinary recoveries were 9.4 +/- 2.4% to 31.6 +/- 19.0% in 6 hours after administration. 2. Clinical investigation Clinical study was carried out in 24 patients of respiratory infections. Clinical efficacies were excellent in 11 patients, good in 12 patients and fair in 1 patient. The clinical efficacy rate was 95.8%. No side effects were observed. The above results suggest that TE-031 is a useful oral antibiotic for treating pediatric respiratory infections, especially those due to Mycoplasma pneumoniae.

Control of the larynx in patients with obstructive and restrictive pulmonary impairment

To study changes in glottic movements associated with pulmonary functional abnormalities, we measured changes in glottic resistance (Rgl) during quiet tidal breathing in normal subjects (N), patients with chronic obstructive pulmonary disease (COPD) and patients with idiopathic pulmonary fibrosis (IPF). Changes in Rgl were measured with a non-invasive method using low frequency sound. Changes in Rgl were tightly coupled to changes in tidal volume and were reproducible in all subjects. Rgl was higher during expiration than during inspiration in N and COPD. COPD showed greater changes in Rgl between inspiration and expiration than did N. However, Rgl did not differ between inspiration and expiration in three of six IPF, and was lower during expiration than during inspiration in two of six IPF. We suggest that glottic movements during quiet tidal breathing change in association with the functional abnormalities of pulmonary diseases.

Control of the larynx in patients with obstructive and restrictive pulmonary impairment

To study changes in glottic movements associated with pulmonary functional abnormalities, we measured changes in glottic resistance (Rgl) during quiet tidal breathing in normal subjects (N), patients with chronic obstructive pulmonary disease (COPD) and patients with idiopathic pulmonary fibrosis (IPF). Changes in Rgl were measured with a non-invasive method using low frequency sound. Changes in Rgl were tightly coupled to changes in tidal volume and were reproducible in all subjects. Rgl was higher during expiration than during inspiration in N and COPD. COPD showed greater changes in Rgl between inspiration and expiration than did N. However, Rgl did not differ between inspiration and expiration in three of six IPF, and was lower during expiration than during inspiration in two of six IPF. We suggest that glottic movements during quiet tidal breathing change in association with the functional abnormalities of pulmonary diseases.

[Pharmacokinetic and clinical studies of sultamicillin fine granules in children]

Sultamicillin (SBTPC) is a semi-synthesized beta-lactam antibiotic consisted of ampicillin (ABPC) and a beta-lactamase inhibitor, sulbactam (SBT), linked with an ester linkage. Pharmacokinetic and clinical studies using SBTPC 10% fine granules were performed in pediatric patients with a variety of infections. 1. Pharmacokinetic investigation: SBTPC was given at 30 minutes after meal at a dose of 10 mg/kg. Peak serum levels were attained at 1 hour after dosing with average levels of 3.83 +/- 0.27 micrograms/ml for ABPC and 2.73 +/- 0.30 micrograms/ml for SBT. The average half-life of ABPC was 1.52 +/- 0.25 hours and that of SBT was 1.13 +/- 0.09 hours. The urinary recovery rate of ABPC during 6 hours after dosing was 58.2 +/- 4.9% and that of SBT was 59.7 +/- 6.4%. 2. Clinical investigation: Enrolled in the study were a total of 26 patients including 12 with tonsillitis, 6 with pharyngitis, 5 with urinary tract infections, and 1 each with bronchitis, with Salmonella enteritis and a case with fever of unknown case. Responses were excellent in 15 patients, good in 8, fair in 2 and poor in 1 with an efficacy rate of 88.5%. In the assessment of the bacteriological efficacy, 11 out of 14 strains of organisms isolated previous to the treatment were eradicated, 1 strain was found reduced in number and 2 strains remained unchanged with an eradication rate of 78.6%. One patient (3.8%) out of the 26 had diarrhea as side effects and 3 patients (16.7%) of 18 showed eosinophilia in laboratory examinations.

Partitioning of large and small airway resistance in human measured by an anterograde catheter with a tip micromanometer

We measured lateral pressure in airways 3 mm in internal diameter in three normal subjects using an anterograde catheter with a tip micromanometer. The pressure was used to partition total pulmonary resistance into a large airway resistance component between the mouth and the pressure sensor and a small airway resistance component between the pressure sensor and alveoli. Large airway resistance and small airway resistance during inspiration were 2.3 +/- 0.4 and 0.9 +/- 0.2 cmH2O/liter/sec (mean +/- S.E.), respectively, and small airway resistance was 29% of the total pulmonary resistance. We suggest that the present technique may be useful for determining the localization of airway resistance in human subjects.

Serial distribution of bronchoconstriction in normal subjects. Methacholine versus histamine

We compared the relative sites of airway responses to methacholine and histamine aerosols in normal subjects by simultaneous assessment of respiratory resistance (Rrs) and anatomic dead space (VD). Methacholine (12.5 mg/ml) or histamine (12.5 mg/ml) was continuously inhaled during tidal breathing until a nearly twofold increase in Rrs was observed. Large airway response was determined by VD, and overall airway response was determined by Rrs. Small airways response was inferred from Rrs when the change in VD was slight. Inhalation of methacholine and histamine increased Rrs with decreased VD, but the decrease in VD was significantly greater with methacholine than with histamine for an equivalent change in Rrs (p less than 0.01). Inhalation of atropine (5 mg/ml) decreased Rrs with a simultaneous increase in VD. After inhalation of atropine, time required for a twofold increase in Rrs by histamine inhalation was prolonged, and histamine did little decrease VD. These results suggest that the predominant site of cholinergically mediated constriction is the large airways, and that histamine constricts the large airways in part via a cholinergic reflex mechanism and constricts the small airways via its direct action in normal subjects.