A clinical study of total cystectomy for transitional cell carcinoma of the urinary bladder

Fifty six patients with transitional cell carcinoma of the urinary bladder were treated by total cystectomy from January, 1979 through December, 1988. A retrospective study was conducted on 52 patients on whom prognosis could be followed up. There were 40 men and 12 women (male to female ratio: 3.3: 1), between 32 and 79 years old (mean age, 64.1 years old). The overall 1-, 3- and 5-year survival rates were 65.8%, 54.1% and 43.0%, respectively. The 5-year survival rates for patients with low grade (G, I, II) and high grade (G. III) were 41.9% and 42.7%, respectively: with no significant difference in the survival curves between the two groups. The 5-year survival rates according to histopathological stage were 78.9% for patients in low stage, 24.7% in high stage, and the difference in the survival curves between the two groups was statistically significant (P less than 0.001). The mortality in the 21 cases of the 33 high stage cases in which cisplatin was used was 42.9%, with 3- and 5-year survival rates were 53.1% and 36.8%, respectively. In the remaining 12 cases in which cisplatin was not used for post-operative chemotherapy, the mortality in the 12 cases was 83.3%, with 3- and 5-year survival rates of 25.1% and 12.3%, respectively. Thus, the patients who received post-operative chemotherapy showed a better survival rate than those who did not with a significant difference (P less than 0.05). The results of the present study suggest the usefulness of post-operative adjuvant chemotherapy in the high stage case.

[The effect of the local anesthesia to the posterior ramus of the mandible in patients with temporomandibular joint problems]

Some clinicians in North America use anesthetic injections to differentiate the symptoms such as pain and stiffness in the facial area and neck in patients with TMJ problems. However, the effects and area which is influenced have not been studied. The purpose of this study was to study procedures and changes following administration of local anesthesia to the posterior ramus of the mandible. Twenty four patients with TMJ problems were used in this study. 0.5ml of 2% Lidocaine (epirenamine included) was injected into the most painful site upon palpation. The pain upon palpation test (following Krogh-Poulsen's method) was compared before and after 50 minutes. Results of this experiment were: 1) decrease of pain upon palpation was found not only in the site. In many cases subjective pain in the head and neck area was also reduced. 2) A significant reduction was found in the pain upon palpation test in the neck area. A highly significant reduction was seen in the Sterunoclydmastoid muscle only in the injected side. In the masticatory muscles. Also, reduction of pain upon palpation was seen in both lateral, medial pterygoid and digastric muscles in the injected side. 3) Contra side lateral pterygoid muscle and trapezius muscle also registered decreased pain upon palpation. 4) The mean values for the injected site were 5.7mm (S.D. 5.9) below the earlobe and the mean depth from the skin surface to the bony surface were 16.6 mm (S.D. 2.7mm). 5) The peak of the subjective effect were seen in one group in 20 minute later injection (early type) and in the 2nd group the peak were seen after 40 minutes (slowly type). 6) We did not experienced any paralysis of the facial nerve in this study.

[Craniomandibular disorders management (1) Treatment planning]

Various treatment modalities have been reported in the management of the craniomandibular disorders in the half century after Costen reported his hypothesis on the temporomandibular disorders. Recent advances in the basic sciences such as anatomy, histology, pathology, physiology and clinical trials have brought us to this new era. We have been trying to establish our diagnosis and treatment modalities in the management of the craniomandibular disorders over the past fifteen years. In this series of articles we will describe our present concept. We will first discuss diagnosis and treatment planning. After the diagnosis and initial treatment planning craniomandibular management is usually divided into two phases. Phase I is the treatment of the stomatognathic system especially the temporomandibular joint. Behavioral modification and physical therapy and splint therapy are the most common forms of treatment. Sometimes, surgical treatment is required. Phase II is the compensatory phase of the occlusion consisting of occlusal equilibration, occlusal restorations, orthodontic treatment and gnathic surgery if needed. Another phase we like to add is maintenance. In this phase, home therapy, corrective follow-up and long term observation should be emphasized. The motivation of the patient throughout the management of the craniomandibular disorder (phase I, phase II and the maintenance phase) is essential to reach to a successful result.

Effects of halothane on the efflux of [3H]D-aspartate from rat brain slices

The in vitro effects of halothane on the potassium-stimulation-induced efflux of [3H]D-aspartate in rat cerebral cortex slices were studied. The slices were initially incubated with Krebs-Ringer's solution containing [3H]D-aspartate, a putative excitatory transmitter. The slices were then stimulated with high concentrations of K+ in the presence and absence of halothane, and the efflux was measured using a scintillation counter. Halothane, 1% and 2%, had little effect on the potassium-stimulation-induced efflux, but that of 4 and 8% increased the efflux significantly. The spontaneous efflux was unaffected by all concentrations of halothane studied. The control study of pentobarbital, in the concentration of 0.05 to 1.00 mmol/l, reduced the efflux in a dose-related manner. These findings indicate that the release of an excitatory transmitter, aspartate, may not be involved in the mechanism of halothane anaesthesia.

[Detection of beta-lactamase-producing strains isolated from urinary tract and their drug susceptibility]

A total of 518 bacterial strains isolated from the urine of patients with various urological diseases in our Urological Department between November, 1987 and February, 1989 were studied for their beta-lactamase production and susceptibility to various antimicrobial agents was determined. beta-lactamase activity was determined by the acidometry disc method. There were 241 gram-positive cocci, 276 of gram-negative rods and 1 Neisseria gonorrhoeae. Thirty-four percent of the gram positive and 76.3% of gram negative rods produced beta-lactamase. S. aureus (81.3%), S. epidermidis (65.1%) in gram-positive cocci, E. cloacae (100%), S. marcescens (100%), C. freundii (100%), P. aeruginosa (97.2%), P. Rettgeri (88.9%), E. gergoviae (85.7%), K. oxytoca (84.6%), M. morganii (81.8%) and E. coli (69.0%) in gram-negative rods produced beta-lactamase at a higher rate. beta-lactamase produced by gram-positive cocci was entirely penicillinase, and that produced by gram-negative rods only penicillinase in 4.0%, only cephalosporinase in 44.2% and both in 25.4%. In S. aureus and S. epidermidis, the isolated rate of strains resistant to ampicillin (p less than 0.01) and piperacillin (p less than 0.05) in the beta-lactamase producing strains was significantly higher than that in the beta-lactamase non-producing strains. In E. coli, the isolation rate of strains resistant to ampicillin and piperacillin in the penicillinase-producing strains was significantly higher than in the penicillinase non-producing strains (p less than 0.01). But both cephalosporinase-producing strains and beta-lactamase non-producing strains showed high susceptibility to cephalothin. These results suggest that the penicillinase might present a clinical problem in the treatment of urinary tract infections by S. aureus, S. epidermidis and E. coli.

Effects of thiobarbiturates on smooth muscle reactivity in isolated aortas from spontaneously hypertensive rats

The direct effects of thiobarbiturates on helical strips of aortas from spontaneously hypertensive (SH) rats were compared with those from Wistar-Kyoto (WKY) rats. At 5-6 wk of age, the arterial pressure of SH and WKY rats did not differ, and the effects of thiobarbiturates on aortic strips from SH and WKY rats were similar. By contrast, at the age of 10-12 or 20-21 wk arterial pressure was higher in SH than in WKY rats, and responses to thiobarbiturates differed in aortic strips from SH and WKY rats: contractile responses were greater in WKY than in SH rats, and relaxing effects were greater in SH than in WKY rats. Responses to sodium nitroprusside did not differ in the aortas of SH and WKY rats, but the effects of nifedipine were greater in strips from SH rats than from WKY rats at the age of 10-12 wk. Ca2(+)-induced contractions of strips exposed to Ca2(+)-free media and depolarized by high K+ were inhibited by treatment with thiamylal; the inhibition was greater in SH than in WKY rats. The increase in smooth-muscle relaxation induced by thiobarbiturates in strips from SH rats may be due to increased sensitivity to the Ca2(+)-channel blocking action of thiobarbiturates.

Contribution of prostacyclin to D-tubocurarine-induced hypotension in humans

In order to evaluate the role of prostacyclin in d-tubocurarine-induced hypotension in human, the authors examined the relationship of changes of arterial blood pressure and plasma 6-keto-PGF1 alpha level following iv administration of d-tubocurarine (dTc), with or without prior administration of aspirin and H1 antagonist. The bolus injection of dTc 0.6 mg/kg caused a significant decrease in mean arterial pressure (MAP) that was associated with a significant increase in plasma 6-keto-PGF1 alpha (P less than 0.05 in both). The maximum MAP decrease and plasma 6-keto-PGF1 alpha increase were noted at 2 min after dTc administration. Pretreatment with aspirin DL-lysine (25 mg/kg) or diphenhydramine (1 mg/kg) significantly attenuated the responses of MAP (P less than 0.05 in both) and plasma 6-keto-PGF1 alpha level (P less than 0.01 for aspirin group, P less than 0.05 for diphenhydramine group). There was a significant correlation between the changes in plasma 6-keto-PGF1 alpha and those in MAP (Kendall tau (tau) = -0.504, P less than 0.01). These findings suggest that a bolus injection of dTc induces a release of prostacyclin through H1 receptor, which is responsible for the dTc-induced transient decrease of blood pressure in humans.

[Total gastrectomy after VEPA therapy in a case of primary gastric lymphoma (stage III of Naqvi's clinical staging)]

A 51-year-old male was referred to our hospital with complaints of chest and back pain. He was diagnosed as primary gastric lymphoma after medical examination. Because of a spreading of the lesion and his poor condition, we concluded that a curative operation would be impossible, and used VEPA therapy as combination chemotherapy. After three cycles of VEPA therapy, the man underwent total gastrectomy, which resulted in better prognosis and no malignant cells in the resected stomach. According to Naqvi's clinical staging, stage III gastric lymphoma is inoperable. We report here a case of stage III gastric lymphoma which could undergo curative operation after chemotherapy and continue to be in good condition.

[Malignant mesodermal mixed tumor of the bladder: report of a case]

An 81-year-old woman was admitted to our clinic due to gross hematuria. A large bulky pedunculated mass was found in the bladder by cystoscopic examination. Subtotal cystectomy and bilateral cutaneostomy was performed on January 12, 1987. Histologically the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was composed fundamentally of grade 2, transitional cell carcinoma with numerous foci of squamous metaplasia. The sarcomatous element was composed of myxosarcomatous, chondro-sarcomatous pattern and non-differentiated malignant spindle cell component. Immunohistochemical examination demonstrated the presence of cytokeratin and epithelial membrane antigen in the spindle cell and more obvious carcinomatous regions, using the avidin-biotin conjugated immunoperoxidase technique. The patient died 3 months after operation. Autopsy findings showed multiple organ metastasis which were composed of carcinomatous and sarcomatous elements.

Cardiopulmonary responses to the tracheobronchial suction with a fiberoptic bronchoscope during and after anesthesia

The cardiopulmonary responses to endobronchial suction with a fiberoptic bronchoscope (FOB suction) during and after anesthesia were compared in 12 patients underwent elective surgeries. FOB suction for 1 mm was performed during enflurane anesthesia (1.5% enflurane in oxygen) with muscle relaxant (anesthetized stage) and after anesthesia during spontaneously breathing of oxygen (awake stage). FOB suction lowered PaO2 to a greater extent in the awake than in the anesthetized stage. Mean PaO2 decreased from 414 to 111 torr in the awake and from 447 to 333 in the anesthetized stage. During suction, PaCO2 slightly increased in both stages. In response to FOB suction, heart rate increased significantly in the awake stage (P < 0.001), while mean blood pressure increased significantly in the anesthetized stage (P < 0.01). These findings indicate that the cardiopulmonary responses to FOB suction for 1 min during and after anesthesia differed. The procedure might be less dangerous during anesthesia.

The contractile responses of isolated dog cerebral and extracerebral arteries to oxybarbiturates and thiobarbiturates

In helical strips of dog cerebral, coronary, mesenteric, renal, and femoral arteries, the addition of thiamylal and thiopental, 10(-5) to 10(-3) M, caused a dose-related contraction; the contraction was significantly more intense in cerebral than in extracerebral arteries. Secobarbital caused a slight contraction only in the cerebral artery. In contrast, pentobarbital did not produce a contraction in any artery studied. The thiamylal-induced contraction was not affected by treatment with phentolamine, diphenhydramine, or cinanserin but was attenuated by treatment with Ca entry blockers, such as nifedipine or diltiazem. In the cerebral artery soaked in Ca++-free media for 60 min, the addition of Ca++ produced triphasic responses; a transient contraction followed by a relaxation and a slowly developing, persistent contraction. The persistent contraction was potentiated by 10(-4) M thiamylal but abolished at 10(-3) M. In the mesenteric artery soaked in Ca++-free media, the addition of Ca++ produced only a slight contraction, which was potentiated by thiamylal (10(-4) and 10(-3) M). It is concluded that thiobarbiturates are more potent vasoconstrictors than oxybarbiturates and that the barbiturates produce greater contraction in cerebral arteries than in extracerebral arteries. The thiamylal-induced contraction appears to be associated mainly with influx of Ca++ from extracellular fluids.

[Chronological changes in bacteria isolated from the urinary tract and their drug sensitivities]

Statistical studies were performed on bacterial strains isolated from the urine of patients with various urological disease in our Urological Department between January, 1983 and December, 1987. In 1987, sensitivity tests of antibiotics to various pathogens were carried out. From the outpatients, 5,725 bacterial strains were isolated. S. epidermidis was isolated most frequently (23.8%), followed by Enterococcus species (16.5%), E. coli (14.7%), Streptococcus species (12.6%), Proteus species (5.3%), other GNR (4.6%), P, aeruginosa (4.5%), Klebsiella species (4.4%), and others. From the inpatients, 4,747 bacterial strains were isolated. Enterococcus species was isolated most frequently (23.1%), followed by S. epidermidis (18.7%), Fungi (12.9%), P. aeruginosa (8.0%), other GNR (6.8%), Streptococcus species (5.4%), Enterobacter species (4.8%), E. coli (4.1%), S. aureus (4.1%) and others. Annual change of distribution of organisms indicated that S. aureus from outpatients had a tendency to increase and Streptococcus species had a tendency to decrease. Whereas from inpatients, E. coli, other GNR, Pseudomonas species and Enterobacter species had a tendency to increase, and Streptococcus species, P. aeruginosa, Proteus species and Klebsiella species had a tendency to decrease. S. epidermidis showed a high sensitivity to minocycline and cephalothin, and Enterococcus showed a high sensitivity to ampicillin and minocycline, but did not show good sensitivity to cefoperazone and latamoxef. E. coli showed a high sensitivity to all drug we tested. P. aeruginosa showed a high sensitivity to gentamycin and norflaxacin, but did not show good sensitivity to other many drugs we tested.

Mechanisms underlying response to hypercapnia and bicarbonate of isolated dog cerebral arteries

In helical strips of dog cerebral arteries contracted with K+ or prostaglandin F2 alpha, the increase in CO2 from 5 to 15% in the gas aerating the bathing media produced a persistent relaxation in association with a rise of PCO2 and a fall of pH and PO2. Elevation of the NaHCO3 concentration from 25 to 75 mM in the bathing media under hypercapnia almost reversed the arterial tone when the osmolarity was balanced; the pH was completely reversed, whereas PCO2 was maintained at the high level. When 50 mM NaHCO3 were applied to the hypercapnic media without having the osmolarity balanced, the arteries relaxed further. Infusions of the HCl solution lowered the pH and relaxed the arterial strips; however, such a relaxation was significantly less than that caused by hypercapnia-induced acidosis. Relaxant responses to hypercapnia were attenuated by treatment with ouabain but were not influenced by amiloride and superoxide dismutase or by removal of endothelium. Relaxations due to hypertonic NaHCO3 were abolished or reversed to contractions by ouabain and were reduced by treatment with amiloride. It may be concluded that the hypercapnia-induced cerebroarterial relaxation is associated mainly with a fall of extracellular pH and is mediated partly by an activation of the electrogenic Na+ pump. Cerebral vasodilatation by increased osmolarity with NaHCO3 appears to result from stimulated Na+-H+ exchange and activated Na+ pump.

[A case of signet ring cell carcinoma of the urinary bladder]

A 67-year-old man was admitted for complaint of gross hematuria on April 9, 1986. Cytoscopic examination was revealed broad-base tumor, its size was thumb's head, at the right lateral wall of the bladder. Ultrasonography and computed tomographic scan of the bladder demonstrated no evidence of invasion to adjacent organs. The biopsy showed signet-ring cell carcinoma. Radiography of the digestive organs showed no abnormality. A partial cystectomy was performed. Histologically the tumor was limited up to submucosa, that is pT1b. The localization of carcinoembryonic antigen (CEA) on tissue of our case, using the peroxidase-antiperoxidase (PAP) method, was evidenced.

The study on cell surface antigens in epithelial tumor of the upper urinary tract: ABH-isoantigen and Thomsen-Friedenreich antigen

ABH-isoantigen (ABH-Ag) and Thomsen-Friedenreich antigen (T-Ag) were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method on 47 patients with epithelial tumor of the upper urinary tract (all patients underwent nephroureterectomy including the cuff of the bladder; 30 patients were diagnosed as transitional cell carcinoma of renal pelvis and 17 ureteral organs). The correlations between ABC expression for ABH-Ag and T-Ag with histological grade, stage and prognosis (5 year survival rate) were studied. A correlation was observed between grade (p less than 0.05) and deletion of the antigenicity of ABH-Ag, but no correlation was evident with stage and prognosis. A high correlation was evident, however, between grade (p less than 0.01), stage (p less than 0.01) and prognosis (p less than 0.01) and deletion of the antigenicity of T-Ag. The analysis of ABC expression for ABH-Ag and T-Ag may therefore be valuable for predicting the malignant potential in transitional cell carcinoma of the upper urinary tract. T-Ag determination in particular may provide a useful prognostic probe should it find clinical application.

A graphic comparison of mandibular border movements generated by various articulators. Part II: Results

A method was described in Part I in which mandibular border movements of a subject can be compared with the movements generated by various articulators (fully adjustable Denar SE and semiadjustable Denar Mark II) by using an electronic pantograph, the Pantronic. The mean values of 12 sets of plots from this device were calculated and graphs were generated. For the subject studied, differences were detected by the Pantronic pantograph between human border movements and those generated by each articulator and method of adjusting it. In the horizontal table, the semiadjustable articulator without immediate side shift always showed the potential of greater errors, especially as excursions started. When the semiadjustable instrument was programmed with immediate side shift, its movements were comparable with the fully adjustable articulator. Neither articulator exactly simulated the subjects' movements.

Intravenous administration of isosorbide dinitrate attenuates the pressor response to laryngoscopy and tracheal intubation

In order to evaluate the effect of isosorbide dinitrate (ISDN), administered as a bolus intravenous injection, on the circulatory response to tracheal intubation, mean arterial pressure (MAP), and heart rate (HR) in response to laryngoscopy for 30 s followed by tracheal intubation were compared in patients not receiving ISDN (control) and receiving 40 micrograms/kg or 80 micrograms/kg of ISDN 45 s before starting laryngoscopy. Each group consisted of 10 patients undergoing elective surgery. Forty-five seconds after starting laryngoscopy, MAP was significantly (P less than 0.01) lower in patients receiving 80 micrograms/kg ISDN than in those receiving no or 40 micrograms/kg ISDN. HR increased to a similar extent in the three groups. These results indicate that a bolus injection of ISDN (80 micrograms/kg) is a simple, practical and highly effective means of attenuating the hypertensive response to direct laryngoscopy and tracheal intubation.

Membrane potential in liposomes measured by the transmembrane distribution of 86Rb+, tetraphenylphosphonium or triphenylmethylphosphonium: effect of cholesterol in the lipid bilayer

Valinomycin-induced potassium diffusion potential (delta psi, inside negative) in the liposomes made of phosphatidylcholine and various amounts of cholesterol was measured by uptake of 86Rb+, tetraphenylphosphonium (TPP+) or triphenylmethylphosphonium (TPMP+). In any liposome, the values of membrane potential obtained by 86Rb+ uptake (delta psi Rb) agreed well with those calculated from the imposed potassium concentration gradient using the Nernst equation, and were not affected by the presence of cholesterol. However, both delta psi TPP and delta psi TPMP showed smaller values than delta psi Rb when the cholesterol content in liposomes increased. delta psi TPMP at a stationary state was much smaller than delta psi TPP. The orientational order parameter of the lipids' bilayer with various cholesterol content was estimated from fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene. The results indicated that the permeation of TPP+ or TPMP+ into liposomes containing a large amount of cholesterol is strongly restricted by the high ordering of phosphatidylcholine acyl chains.

Transthoracic resection of esophageal cancer in patients with pulmonary dysfunction. Usefulness of high frequency ventilation during thoracotomy

Although curative resection of esophageal cancer has become a safe procedure, in patients with pulmonary dysfunction, postoperative complications remain a serious problem. Of 122 patients who had transthoracic resection of esophageal cancer, 27 had pulmonary dysfunction; in six, the forced vital capacity was less than 70% (minimum of 42.8%, mean +/- SD of 56.6 +/- 8.9%); in 18, forced expiratory volume for one second (FEV1%) was less than 70% (minimum of 34.6%, mean +/- SD of 60 +/- 10%); and in three, both forced vital capacity and forced expiratory volume was less than 70%. Two patients had undergone hemipneumonectomy before receiving resection of the esophagus. During the intrathoracic operative procedure, high frequency ventilation was used, providing good surgical exposure and contributing to a decrease of postoperative pulmonary complications. There were no deaths during the month after surgery. The survival curve of these patients was not significantly different from that of other patients who had had esophagectomy for cancer of the esophagus. These patients survived for an average of 24 months. The patient who survived the longest has been alive for more than 11 years.

A graphic comparison of mandibular border movements generated by various articulators. Part I: Methodology

A method was described by which mandibular border movement of a subject can be compared with the movements generated by various articulators. The fully adjustable articulator, Denar SE, and the semiadjustable instrument, Denar Mark II, were used in this study. The movements were recorded by an electronic pantograph, the Pantronic. The mean values of 12 sets of print-out plots from this device were calculated by using Microsoft Excel software. These mean values were then used by CricatGraph software to generate combined graphs. Both software programs were used with an Apple Macintosh Plus personal computer. The clinical significance of the findings will be discussed in Part II of this study.

Common peroneal nerve palsy. A complication of coronary artery bypass grafting surgery

Two cases of common peroneal nerve palsy after coronary artery bypass grafting surgery are described and the possible causative mechanisms are discussed.

The site of action of trimethaphan-induced neuromuscular blockade in isolated rat and frog muscle

The present study was undertaken to determine the site of action of trimethaphan in causing neuromuscular blockade using isolated rat and frog muscle. Trimethaphan and d-tubocurarine attenuated the twitch tension developed by nerve stimulation, trimethaphan being 1/100 to 1/200 as potent as d-tubocurarine. Neostigmine potentiated the inhibitory effect of trimethaphan but reversed the effect of d-tubocurarine. Trimethaphan shifted the dose response curve of frog rectus abdominis muscle for carbachol downwards, while d-tubocurarine shifted the curve parallel to the right. Treatment with d-tubocurarine or succinylcholine protected acetylcholine receptors from persistent blockade by alpha-bungarotoxin while, in contrast, trimethaphan failed to protect the receptors. The findings indicate that trimethaphan acts on the motor endplate but, unlike d-tubocurarine, does not interact with the recognition site of acetylcholine receptors; the action of trimethaphan appears to be associated with the blockade of endplate ionic channels.

[Study of the Thomsen-Friedenreich antigen in bladder tumors]

Thomsen Friedenreich antigen (T-ag), ABH isoantigen (ABH-ag) in 106 cases with bladder tumor (all transitional cell carcinoma) of various histological grades and stages were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method. There was a correlation between histological grade, stage and deletion of the antigenicity (T-ag and ABH-ag). In a follow-up study of 45 patients with low grade and low stage tumor, the recurrence rate after surgery of the cases with abnormal antigenicity (T-ag and ABH-ag) was significantly higher than that of the cases with the normal antigenicity. Combination of two markers (T-ag and ABH-ag) was significantly more effective than the single marker.

[Study on heterotransplantation of human malignant urogenital tumors in nude mice: establishment of the tumor line in nude mice from human primary ureteral tumor and its characteristics]

The tumor line in nude mice is one of the most important experimental animal models for oncodevelopmental studies. We implanted a human ureteral tumor into nude mice, established the tumor line, AM-UT-1, and maintained it by serial transplantation. The characteristics of this tumor line in nude mice are reported. Histologically, the original tumor was a transitional cell carcinoma (grade II, stage B). The transplanted tumor grew locally and had a constant growth pattern during serial passage until the 13th passage in nude recipients and maintained the basic histological, immunohistochemical findings of the original tumor. Both original tumor and serial transplanted tumor had carcinoembryonic antigen (CEA)-producing activity. A high level of serum CEA was also recognized in nude mice.

Transcutaneous monitoring during high-frequency jet ventilation

Simultaneous transcutaneous PO2 (PtcO2) and PCO2 (PtcCO2) recordings, done on a patient during high-frequency jet ventilation (HFJV) in thoracic surgery, reflected exactly PaO2 and PaCO2 changes induced by surgical manipulation and by ventilator setting alterations. PtcO2 and PtcCO2 monitoring with a single sensor was valuable during HFJV for the early detection of acute changes in the efficacy of gas exchange and for the correction of the ventilator setting.

Cadaver anatomic analysis of the best site for chemical lumbar sympathectomy

The lumbar sympathetic ganglia and their surroundings were examined anatomically in 19 human cadavers. The locations of the ganglia on the lumbar vertebral column at the level of the second and third lumbar vertebral bodies were analyzed statistically using a "ganglion score". The ganglia were most frequently found at the level of the lower third of the second lumbar vertebra, at the L2-3 interspace, and at the level of the upper third of the third lumbar vertebra on both the right and left sides. The points at which the sympathetic chain and the lumbar arteries crossed were at the middle third of the vertebral body in both the second and third lumbar vertebra. These results suggest that the most suitable point for placement of the tip of the needle used for chemical lumbar sympathectomy is not the midpoint of a vertebral body, but rather the lower third of the second vertebral body or the upper third of the third vertebral body.

[The study of the ABH isoantigen of bladder tumors]

ABH isoantigens in 82 cases with bladder tumor of various grades and stages were investigated by the avidin-biotin-peroxidase complex (ABC) method. Correlation of ABC expression for isoantigens with pathological findings on the grading and staging system of the bladder tumors were as follow: Of 60 cases of low grade tumors, 34 (56.7%) were positive and of 22 cases of high grade tumors, 21 (95.5%) were negative. Of 63 cases of low stage tumors, 35 (55.6%) were positive and all 19 cases of high stage tumors, (100%) were negative. The isoantigens in the tissue of the bladder tumors tended to disappear as the histologic anaplasia of the tumor progressed. There was a high correlation between the histological grade, stage and ABC expression (p less than 0.01). In a follow-up study of 38 patients with low grade, low stage, initial transitional cell carcinoma, 9 of the 24 patients positive for ABC expression (37.5%) showed recurrence during the 1 to 6 year follow-up period, whereas 10 of the 14 patients negative for ABC expression 10 (71.4%) did. There was a high correlation between the recurrence rate and ABC expression (p less than 0.05). Therefore, the analysis in the bladder tumors may be valuable for prediction of malignant potential, especially for the low grade, low stage tumors.

Simultaneous determination of membrane potential and pH gradient by photodiode array spectroscopy

Membrane potential (delta psi) and pH difference (delta pH) were simultaneously determined in liposomes using a photodiode array spectrophotometer. By the use of a cyanine dye (DiS-C3(5)) and 9-aminoacridine for delta psi and delta pH probes, respectively, both changes of delta psi and delta pH could be successfully determined by photodiode array spectrometry. Each dye did not disturb the fluorescence spectrum of the other probe when its concentration was lower than 5 microM. The K+-diffusion potential-driven, FCCP(protonophore)-mediated H+-influx process in the K+-loaded liposomes was analyzed by this method. Results indicate that the kinetic behavior of H+ influx changes at a FCCP concentration of approx. 30 nM. The rate of delta pH formation increased quantitatively with increasing concentrations of FCCP up to 30 nM, but was markedly enhanced at higher concentrations, although the maximal delta pH attained was about 3 pH units in any case when a K+-diffusion potential of -180 mV was applied.

[Clinical experience with T-2588 in complicated urinary tract infections]

The clinical effectiveness and safety of T-2588 were evaluated in 21 patients with complicated urinary tract infections. Six hundred mg of T-2588 per day was administered orally in three divided doses for 14 days. The results were excellent in 7 cases (33.3%), moderate in 8 cases (38.1%) and poor in 6 cases (28.6%), and the effectiveness rate was 71.4%. The effectiveness rates of the single infection group and mixed infection group were 91.7% and 44.4%, respectively. The overall bacteriological eradication rate obtained was 77.1%, and those of gram-positive cocci and gram-negative rods were 62.5% and 81.5%, respectively. None of the 21 cases, had any significant side effects and abnormal laboratory findings. From the above results, T-2588 is considered to be a useful antibiotic in the treatment of complicated urinary tract infections.

Acute tolerance development to the cardiovascular and subjective effects of cocaine

Eight normal adult volunteer subjects received an intranasal pretreatment of either 4 (placebo) or 96 mg of cocaine. Sixty minutes later 16, 32 or 48 mg of cocaine was injected i.v. Cocaine plasma levels were determined periodically over a 2-hr period and both cardiovascular effects and verbal report of drug effects were monitored for 8 hr daily. The plasma concentrations of cocaine were always related to the dose administered. When i.v. cocaine was given after a 96-mg intranasal pretreatment, the increase in heart rate was not as great as when an i.v. injection followed a 4-mg inhalation. Comparable changes were obtained in subjective effects as measured on the Addiction Research Center Inventory, the Profile of Mood States and a subjective effects questionnaire. These results suggest that there is a decrease in physiological and subjective effects of cocaine when administered repeatedly in humans. This acute tolerance appeared to have dissipated within 24 hr.

Real-time analysis of the change in arterial oxygen tension during endotracheal suction with a fiberoptic bronchoscope

An intra-arterial Clark-type polarographic oxygen electrode was used with a fiberoptic bronchoscope for real-time analysis of the PO2 change during 1 min of suction in patients spontaneously breathing oxygen. There was a strong correlation between values obtained from the intra-arterial electrode (PiO2) and those from blood samples (PaO2), before and at the end of suction; the PiO2/PaO2 ratio was close to one. Continuous PiO2 recordings during suction without supplemental oxygen showed little change in the early period of suction, followed by a steep drop continuing even after suction. This drop in PiO2 was partially attenuated by providing oxygen with high-frequency jet ventilation and was almost completely attenuated by the use of a suction adaptor. Changes in the inspired oxygen concentration indicated the importance of keeping this variable constant during suction to prevent hypoxemia.