[A Case of Left Renal Cell Carcinoma with Renal Arteriovenous Fistula and Multiple Vascular Malformation Undergoing Nephrectomy]

A 69-year-old woman was referred to our hospital for the treatment of a left renal tumor found by computed tomography (CT) during examination for microscopic hematuria. Contrast-enhanced CT showed a 5 cm tumor in the inferior pole of the left kidney. Left renal cell carcinoma (RCC) (cT1bN0M0) was suspected. In addition, the left renal and gonadal veins were dilated and enhanced in an arterial phase; renal arteriovenous fistula (RAVF) was suspected. Moreover, there were multiple focal arterial dilatations, suggesting the presence of multiple vascular malformation. Hereditary aortic disease, including vascular Ehlers-Danlos syndrome (vEDS), was a concern. In general, surgery is not recommended for patients with vEDS, due to vascular fragility. As such, a panel analysis of genes for hereditary aortic diseases, including vEDS, was performed; no pathogenic variants in candidate genes including COL3A1 were identified. After detailed discussions with the patient, she underwent a left nephrectomy, following transcatheter arterial embolization (TAE) of the left renal artery. We prepared a balloon catheter for aortic occlusion as a preventative measure for massive bleeding; this was not the case, as only a small amount of intraoperative bleeding occurred. Thus, the nephrectomy was performed successfully without using the balloon catheter. The patient recovered uneventfully and was discharged on day 8. Pathological examination showed clear-cell RCC (pT1a) and a RAVF near the tumor. Herein we report this case of left RCC with RAVF and multiple arterial malformation, which was successfully managed by evaluating preoperative risks with a genetic test, followed by TAE of the renal artery and open nephrectomy.

Association between time to lithotripsy and stone-free rate in patients with ureteral stones undergoing shock wave lithotripsy

Early shock wave lithotripsy is associated with higher stone-free rate compared to delayed treatment of ureteral stones, but may constitute overtreatment because ureteral stones can pass spontaneously. We studied the association between time to treatment and stone-free rate in patients with ureteral stones to determine optimal shock wave lithotripsy timing. We retrospectively analyzed 537 patients undergoing shock wave lithotripsy for ureteral stones. Patients were divided into five groups according to time from onset of symptoms to lithotripsy—urgent (0–3 days), early (4–30 days), late (31–60 days), long-delayed lithotripsy (≥ 61 days), and asymptomatic. Stone-free rates were compared among groups. Mean age and stone size were 55.6 ± 13.1 years and 7.48 ± 3.29 mm, respectively. Mean number of shock wave lithotripsy sessions and stone-free rate were 1.37 and 91.6%, respectively, in the overall population. Stone-free rates were 95.2%, 96.8%, 91.3%, 86.3%, and 82.7% in urgent, early, late, long-delayed lithotripsy, and asymptomatic groups, respectively. Long-delayed lithotripsy and asymptomatic groups had significantly more lithotripsy sessions and lower stone-free rate, compared to urgent and early lithotripsy groups. In multivariate analysis, time to lithotripsy [long-delayed lithotripsy (odds ratio: 0.273, p = 0.004) and asymptomatic nature (odds ratio: 0.236, p = 0.002)] and age (odds ratio: 0.959, p = 0.003) independently affected stone-free rate. In conclusion, time to lithotripsy is a strong predictive factor for stone-free status following shock wave lithotripsy. Urgent shock wave lithotripsy did not improve stone-free rate if performed within 1 month. However, time to shock wave lithotripsy > 2 months reduced likelihood of stone-free status.

Persistent anxiogenic effects of a single or repeated doses of cocaine and methamphetamine: interactions with endogenous cannabinoid receptor ligands

As persistent behavioural changes, such as increased anxiety-related behaviours, can be predicted based on the phenomenon of psychostimulant-induced neuronal plasticity, the time course (3-, 5- and 10-day time points) of the effects of both a single and repeated (daily for 7 days) i.p. administrations of cocaine (COC) and methamphetamine (MA) on anxiety-related behavioural symptoms in the elevated plus-maze test were examined in mice. Furthermore, based on the reported interactions between brain dopamine versus cannabinoid (CB) receptors and the contribution of CB receptors to the occurrence of persistent anxiety-related behavioural symptoms, the interactions of the agonist CP 55940 (CP) and the endogenous ligands anandamide (arachidonylethanolamide: AEA), 2-arachidonylglycerol (ARA), N-arachidonyldopamine (NADA), noladin ether (NL), and virodhamine (VA) with the COC- or MA-induced anxiety-related behaviours were also studied. In both an acute experiment using a single COC (30 mg/kg) or MA (4 mg/kg) dose and a chronic experiment using repeated COC (15 mg/kg) or MA (2 mg/kg) doses, anxiety-related behavioural symptoms were observed similarly at 3- and 5-day time points, but disappeared at the 10-day time point. Among the CB ligands, the agonists CP, AEA, ARA, NADA, and NL provided strong protective effects against each parameter at 3- and 5-day time points. Therefore, it was concluded that both COC and MA caused persistent anxiety-related behavioural symptoms following both a single and repeated treatments. Since these anxiogenic effects were attenuated by the endogenous CB agonists, the involvement of brain CB receptors was suspected.

[Acute left ventricular rupture and cardiac tamponade caused by blunt trauma; report of a case]

It is difficult to save patients with acute left ventricular rupture and cardiac tamponade caused by blunt trauma. A 67-year-old man hospitalized due to sustained multiple blunt trauma. The systolic blood pressure was 40 mmHg. Chest computed tomography (CT) and ultrasonic echocardiography revealed cardiac tamponade. Abdominal CT indicated left renal contusion. Pericardial drainage via the subxiphoid approach drew about 1,000 ml of blood from the pericardial sac, which only transiently increased blood pressure. Median sternotomy and subsequent pericardiotomy revealed pulsatile bleeding jet through a laceration of about 2.0 cm long in the left ventricle near the first diagonal branch. After complete digital compression, the portion was covered by a biological tissue adhesive/sealant sheet (TachoComb), which completely suppressed bleeding. The postoperative course was uneventful. He was discharged from the hospital on the 20th day after the operation.

[Coronary artery bypass graftingin a patient with aortitis syndrome; report of a case]

We present a case of surgical treatment for a coronary lesion due to aortitis syndrome. A 41-year-old woman, suffering from aortitis syndrome and under prednisolone (PSL) therapy, underwent coronary artery bypass grafting (CABG). Surgical treatment was performed according to the aortic no-touch technique, but the patient showed a poor cardiac performance 5 days after the operation. This accident was resolved by increasing the PSL dose. Aortitis syndrome treated with PSL needs careful perioperative management besides an operative procedure.

Similar effects of cocaine and immobilization stress on the levels of heat-shock proteins and stress-activated protein kinases in the rat hippocampus, and on swimming behaviors: the contribution of dopamine and benzodiazepine receptors

Cocaine (COC) has been reported to cause effects similar to physiological stressors in the brain neuroendocrinal system, including heat-shock protein (HSP) expression, although these effects have not been elucidated in detail. In the present study, we examined the effects of repeated (4 days) treatments with cocaine hydrochloride (35 mg/kg, i.p.) and 10 min immobilization stress (IM) on the distribution of HSP (HSP27, HSP60, HSP70, HSC70) and stress-activated protein kinase (SAPK) (SAPKalpha, SAPKbeta, SAPKgamma) immunoreactive nerve cells (positive cells) in the rat hippocampus. The swimming behaviors of the rats in the forced swimming test were also examined. In both COC and IM groups, an early enhancement (5 h time point) of hippocampal HSP (HSP27, HSP60, HSP70, HSC70) and SAPK (SAPKbeta, SAPKgamma) positive cells was observed, whereas a recovery (SAPKs) or attenuation (HSP60 and HSC70) was observed at the 24 h time point. In both groups, a depression of the swimming behaviors (attenuation in the activity counts and time until immobility) below the control level was observed at the 5 h point, but a recovery was observed at the 24 h time point. At the 48 h time point, all parameters returned to the control level. These alterations in the levels of HSPs and SAPKs, and the swimming behaviors were similar to those observed in the stress (IM) group, and were characteristic in that all of these alterations were attenuated by the benzodiazepine inverse agonist, Ro 15-4513 (5 mg/kg, i.p.), and the dopamine D1 receptor antagonist, SCH23390 (0.5 mg/kg, i.p.), which was not observed in the groups treated with another stressor-like drug (bicuculline).

[Successful management of traumatic aortic valve insufficiency; report of a case]

A case of the successful management of traumatic aortic valve insufficiency is reported. A previously healthy 48-year-old man sustained multiple injuries in a traffic accident. One month after the accident, heart failure, derived from aortic insufficiency, was noted. Three years and 5 months after the injuries, aortic valve replacement was performed, and a large tear, approximately 7 mm in length, was found in the aortic right coronary cusp. This finding corresponded to the traumatic aortic valve insufficiency. Traumatic aortic valve insufficiency is rare, and early diagnosis may be difficult. Examinations for associated intracardiac injuries should be carefully undertaken.

Protective effects of cannabinoid receptor ligands analogous to anandamide against cocaine toxicity

The effects of the endogenous cannabinoid (CB) anandamide (AEA) and its analogs on cocaine (COCA)-induced toxic symptoms such as lethality, convulsive seizures and hyperactivity were examined in mice. In addition to AEA, the effects of the AEA analogs arachidonyl-2-chloroethylamide (ACEA), arachidonylcyclopropylamide (ACPA) and R-(+)-methanandamide (METH) were compared to the selective and strong CB1 agonist CP 55940 (CP). Intraperitoneal (i.p.) coadministrations of these drugs with COCA (75 mg/kg) demonstrated that AEA (10 and 15 mg/kg), ACEA (5 mg/kg), ACPA (5 mg/kg), METH (5, 10 and 15 mg/kg) and CP (2.5 and 5 mg/kg) all antagonized the COCA-induced lethality, and that ACEA (5 and 10 mg/kg), ACPA (5 and 10 mg/kg), METH (5, 10 and 15 mg/kg) and CP (1, 2.5 and 5 mg/kg) antagonized the COCA-induced convulsive seizures. When alterations in the COCA-induced toxic behaviors were also evaluated by an activity counting instrument, antidotal effects against the COCA-induced hyperactivity were also observed using the above doses. The effects against hyperactivity were stronger in the groups of mice cotreated with CP or ACEA than in the groups of mice cotreated with AEA or METH. However, the antidotal effects against the lethality and convulsive seizures were stronger in the METH-treated group than in the AEA-, ACEA- or ACPA-treated groups, although the selectivity of METH for brain CB1 receptors was lower than for ACEA or ACPA. The correlation with other brain receptors and/or peripheral CB receptors seemed to contribute to the strong antidotal effects of METH, which were not exceeded even by CP.

Protective effects of cannabinoid receptor agonists against cocaine and other convulsant-induced toxic behavioural symptoms

Based on the previously reported co-localization and relationship between cannabinoid and dopamine receptors, the effects of cannabinoid receptor agonists against cocaine-induced toxic behavioural symptoms, including convulsive seizures, were examined in mice. The anticonvulsant effect of several cannabimimetics against seizures induced by other convulsants was also compared. The cannabinoid receptor agonists CP 55940 ((-)-cis-3-[2-hydroxy-4-(1,1-dimethylheptyl)phenyl]-trans-4-(3-hydroxypropyl)-cyclohexanol) and WIN 55212-2 ((R)-(+)-[2,3-dihydro-5-methyl-3-(4-morpholinylmethyl)pyrrolo[1,2,3-de]-1,4-benzoxazin-6-yl]-1-naphthalenylmethanone), and the endogenous cannabinoid anandamide were co-administered intraperitoneally with cocaine (75 mg kg(-1)) or other convulsants such as bicuculline, methyl 6,7-dimethoxy-4-ethyl-beta-carboline-carboxylate (DMCM), L-glutamic acid and N-methyl-D-aspartate (NMDA). CP 55940 (2.5 mg kg(-1)) and anandamide (15 mg kg(-1)) significantly antagonized cocaine-induced lethality, and CP 55940 and WIN 55212-2 (2.5 mg kg(-1)) significantly attenuated the severity of cocaine-induced convulsive seizures. Furthermore, ataxic hyperactivity, which was observed only in the cocaine-treated group of mice and could be evaluated by their activity counts, was also depressed in the groups of mice co-treated with each of the three cannabinoid agonists. However, none of these agonists protected against bicuculline- or DMCM-induced lethality or convulsive seizures. In contrast, all of the cannabinoid agonists, most notably anandamide, antagonized both L-glutamic acid (2 g kg(-1))- and NMDA (200 mg kg(-1))-induced convulsive seizures. These data support the previously reported close correlation between dopamine and cannabinoid receptors, and between cannabinoid agonists, especially anandamide, and glutamate (NMDA) receptors. Furthermore, these results suggest a potential therapeutic role for cannabinoid agonists against cocaine- and other-convulsant-induced toxicities.

Stress-related behavioral alterations accompanying cocaine toxicity: the effects of mixed opioid drugs

The present study evaluated the effects of mixed opioid drugs on the severity of cocaine (COCA) toxicity by examining stress-related behavioral alterations in mice. In order to ascertain the strength of the stress, the continuous observation of the behavioral symptoms in the cage and the forced swimming test (Porsolt test) were performed in the COCA (75 mg/kg, i.p.)-treated groups, with or without the mixed mu-kappa receptor-related opioid drugs, buprenorphine (BUP) and pentazocine (PEN). Using the high-sensitivity activity measuring instrument Supermex, both the spontaneous behaviors in the cage and the forced swimming behaviors in the water were assessed as activity counts. The behavioral alterations in the COCA-treated groups were compared with a group of mice given a 10 min immobilization stress (IM group). In the COCA-only group, a prolonged increase in the spontaneous behaviors accompanied by convulsive seizures was observed even in the surviving mice, unlike in the IM group. However, an acceleration of behavioral despair in the Porsolt test similar to that observed in the IM group was observed in the COCA group after the disappearance of the acute toxic symptoms (5 hours after the COCA treatment). Among the opioid-treated groups, the mortality rate was attenuated only in the COCA-BUP (0.25 mg/kg, i.p.) group. In the COCA-BUP group, a prolonged suppression of the morbid hyperactivity in the cage except for the convulsive seizures, and a normalization of the swimming behavior in the Porsolt test were observed in the survivors. On the other hand, in the COCA-PEN (5 mg/kg, i.p.) group, the swimming behavior in the Porsolt test was abnormally increased in addition to the prolonged morbid hyperactivity in the cage. Therefore, the COCA-induced stress-related behaviors were normalized in the group of mice treated with BUP, a group with a good prognosis.

Comparison of effect of ethanol and anticonvulsants on cardiovascular drug-modified cocaine toxicity

The anticonvulsant (AC drug)- or ethanol (EtOH)-modified effects of cardiovascular (CV) drugs against cocaine (COCA)-induced toxicity were examined in male ICR mice. Nontoxic doses of the CV drugs nimodipine (NIMO), prazosin (PRA), phentolamine (PHEN), propranolol (PRO), and enalapril (ENA) were used with or without the AC drugs diazepam (DZP), phenobarbital (PHB), phenytoin (PHY), and EtOH. Each CV drug combined with or without each AC drug was administered intraperitoneally (IP) 5 min before an IP injection of COCA 75 mg/kg. Of the CV drugs examined, PRA 5 mg/kg and PHEN 5 mg/kg protected against COCA-induced seizures, but only the alpha1-adrenergic blocking agent PRA protected against COCA-induced deaths. Of the AC drugs examined, DZP 5 mg/kg and PHB 50 mg/kg, as well as EtOH 3 g/kg, attenuated the severity of the COCA-induced seizures, but only PHB protected against COCA-induced deaths. The total mortality rate was significantly, often synergistically, decreased compared to the COCA-only group when the appropriate CV drugs were combined with the AC drugs: PRA 5 mg/kg in the EtOH-cotreated groups, PRA 5 mg/kg, PHEN 5 mg/kg or ENA 10 mg/kg in the DZP-cotreated groups, and NIMO 5 mg/kg, PRA 5 mg/kg, PHEN 5 mg/kg, or PRO 10 mg/kg in the PHB-cotreated groups. The decrease in the COCA concentration in the blood and/or brain was not always accompanied by an attenuation of the mortality rate. However, the attenuation of severe seizures by a single PRA, PHEN, DZP, or PHB cotreatment was accompanied by a decrease in the brain COCA concentration.

A new sensitive determination method of estradiol in plasma using peroxyoxalate ester chemiluminescence combined with an HPLC system

A new sensitive determination method of estradiol in a plasma sample using peroxyoxalate ester chemiluminescence was developed. Estradiol, which was extracted by liquid-liquid extraction using ethyl acetate from plasma, was derivatized with dansyl-chloride (DNS-Cl) and separated by reverse-phase HPLC. The performance of four oxalates, bis(trichlorophenyl)oxalate (TCPO), bis(2,4-dinitrophenyl)oxalate (DNPO), bis(pentafluorophenyl)oxalate (PFPO), and bis[4-nitro-2-(3,6, 9-trioxadecyloxycarbonyl)phenyl] oxalate (TDPO), were evaluated using the static system, and DNPO was found to have the most sensitive and stable chemiluminescence at a H(2)O(2) concentration of 30 mM. HPLC-chemiluminescence system using DNPO for the determination of estradiol was established. The detection limit of dansylated-estradiol (DNS-E2) was 15 fmol (4 pg) in the standard solution and 44 fmol (12 pg) in the rat plasma sample at S/N = 3.

Relationship between cocaine-induced hepatotoxic neurobehavioral & biochemical changes in mice: the antidotal effects of buprenorphine

Cocaine (COCA)-induced neurobehavioral symptoms, which can be observed simultaneously with exacerbation in biochemical markers, were evaluated in mice, and compared with the changes observed in a representative hepatic failure model induced by thioacetamide (TAA). The effects of pretreatment with buprenorphine (BUP) (0.25, 0.5 or 1 mg/kg i.p.), a mixed opioid agonist-antagonist and an antidote against fatal COCA toxicity, were also examined. At 5 min after the COCA administration (65 mg/kg i.p.), the liver ATP levels were attenuated, and an exacerbation of the CNS-stimulating effects of COCA could be characteristically observed for hepatotoxicity-related neurobehavioral symptoms (changes in alertness, interest, body tension, head movement and walking). At 24 h, the ALT (alanine aminotransferase) activity was elevated, and hepatotoxic attenuation was observed for all of the scores on the neurobehavioral symptoms; this was almost identical to the symptoms observed in the TAA-treated group of mice. Recovery was observed by 72 h for all of the morbid changes. The hepatotoxic biochemical changes and the sum score for all five neurobehavioral symptoms were significantly ameliorated by low doses (0.25 and 0.5 mg/kg) of BUP, both at 5 min and 24 h.

Effects of ethanol and/or cardiovascular drugs on cocaine- and methamphetamine-induced fatal toxicities in mice

The antidotal effects of antihypertensive cardiovascular (CV) drugs against cocaine (COCA)- and methamphetamine (MA)-induced fatal toxicities were examined in mice. Considering the previously-reported favorable interactions, the effects of CV drugs against combined COCA-ethanol (EtOH) or MA-EtOH toxicities were also evaluated. COCA (75 mg/kg) or MA (18 mg/kg) was administered 5 min after an injection of CV drugs, with or without EtOH (3 g/kg); all drugs were injected intraperitoneally. The CV drugs used were 10 mg/kg diltiazem (DIL), 5 mg/kg nimodipine (NIMO) and 5 mg/kg nitrendipine (NITRE) as calcium channel blockers, 5 mg/kg prazosin (PRA) and 5 mg/kg phentolamine (PHEN) as alpha-adrenergic blocking agents, 10 mg/kg propranolol (PRO) as a beta-adrenergic blocking agent, and 10 mg/kg enalapril (ENA) as an angiotensin converting-enzyme inhibitor. In both the COCA (n = 10) and MA (n = 6) groups, regardless of EtOH or CV drug cotreatment, the fatalities could be divided into the early and late deaths, depending on the survival times, the presence of a temporary recovery from acute toxic symptoms such as observable respiratory and locomotive symptoms, and the presence of the drugs (COCA or MA) in blood samples. The acute toxic symptoms included seizures in both the COCA and MA groups, but they were generally suppressed by EtOH regardless of the mortality rate. Some of the CV drugs, such as PRA and PHEN in the COCA groups and DIL, NIMO, NITRE, PRA and PHEN in the MA groups, also suppressed the seizures. The mortality rate was attenuated by PRA in the COCA groups, and by NIMO, NITRE, PRA and PHEN in the MA groups. In the groups cotreated with EtOH, which has been reported to exacerbate the COCA- and MA-induced cardiotoxicity, the frequency of late deaths was increased. Nevertheless, antidotal effects due to NIMO, NITRE, PRA and ENA in the COCA-EtOH groups, and NIMO, NITRE and PRA in the MA-EtOH groups were observed.

Effect of methamphetamine on male mice fertility

The effect of methamphetamine (MAMP) on the ability of males to mate with females and to impregnate them was examined in 8-week-old ICR mice. Male mice that had been administered an intraperitoneal injection of MAMP (15 mg/kg, 7.5 mg/kg, or 3.75 mg/kg) or saline were housed with females 24 or 48 hours later. The vaginal plugs were checked, and the number of births was counted. The effect of MAMP on sperm motility and the serum testosterone (TS) concentration was also examined. Methamphetamine was observed to have harmful effects only at the highest dose level. In the mice housed 24 hours after the injection of 15 mg/kg MAMP, the increase in the cumulative number of vaginal plugs lagged, and the total number of vaginal plugs decreased significantly. A significant decrease was also observed in the total number of births. Methamphetamine, at a dose of 15 mg/kg, decreased sperm motility. The TS concentration decreased initially, then increased.

Role of cocaethylene in toxic symptoms due to repeated subcutaneous cocaine administration modified by oral doses of ethanol

The present study investigated the toxicity of repeated subcutaneous cocaine administrations combined with oral doses of ethanol, and discussed the role of the toxic metabolite cocaethylene. Subcutaneous cocaine (70 mg/kg) was given to male ICR mice at 45 min after an oral administration of either ethanol (maximum 3 g/kg) (cocaine-ethanol group; n = 50) or saline control (cocaine group; n = 30), once per day, for up to 5 days. In the combined cocaine-ethanol group, the total frequency of death was significantly increased (86%) as compared to the cocaine group (40%). In both administration groups, regardless of the day of death, "late" deaths characterized by the late and unexpected onset of fatal symptoms could be differentiated from "early" deaths on the basis of the survival time after the last cocaine injection, the drug concentrations in the tissues at the time of death, and/or the observed physical disorders. In the combined cocaine-ethanol group, a late death group with survival times exceeding 12 hr and two early death groups could be differentiated, based on the presence or absence of cocaethylene and the different types of clinical symptoms. In the early death group in which cocaethylene could be detected, the volume of ethanol ingested was not significantly different from the late death group with large ethanol consumption and slow exacerbation of the respiratory and locomotive symptoms. Furthermore, the severity of the cocaine-induced seizures was also similarly decreased by ethanol. In the other early death group in which cocaethylene could not be detected, the volume of ethanol ingested was significantly lower than in the late death group, and seizures as severe as in the cocaine-only group were observed.

Numerical analysis for stability and self-excited oscillation in collapsible tube flow

This paper describes numerical analysis of collapsible tube flow based on the one-dimensional distributed parameter model of Hayashi. In the present model the effect of flow separation at the collapsed part is replaced with simple viscous friction along the tube, so no ad-hoc modeling for flow separation in former studies is required. A stable semi-implicit numerical procedure based on the SIMPLE method is developed for the problem of flow and tube interaction. The numerical result for a characteristic self-excited oscillation agrees qualitatively with the experimental result. Nonlinear stability of the steady state dependent on the amplitude of the disturbance is numerically investigated and the result is compared with the linear stability analysis based on the former lumped parameter model. Finally, initiation of the self-excited oscillation is examined by applying the initial disturbance at the upstream end of the tube. The disturbance propagates in the downstream direction and is amplified to the self-excited oscillation.

Brain beta-endorphin immunoreactivity as an index of cocaine and combined cocaine-ethanol toxicities

The present study examines alterations in the cytoplasmic immunoreactivity of brain beta-endorphin, an endogenous opioid peptide regarded as the mediator of both euphoria and antinociceptive systems, in relation to toxicities due to cocaine and combined cocaine-ethanol. Beta-endorphin-immunoreactive cells were visualized and counted in adjacent sections from male rat brains at the level of the arcuate nucleus. In this region, cytoplasmic beta-endorphin immunoreactivity is prevalent. An intraperitoneal injection of cocaine (75 or 15 mg/kg) was given 15 min after an intraperitoneal injection of 3 g/kg ethanol or vehicle. With a fatally toxic dose (75 mg/kg) of cocaine, the number of neurons exhibiting cytoplasmic beta-endorphin immunoreactivity (immunoreactive nerve cells) was significantly increased immediately after the drug administration. Ethanol further enhanced the effects of both 15 and 75 mg/kg of cocaine. When the immunoreactivity was visually estimated by computer imaging analysis, lightly stained, weakly immunoreactive cells with photographic light absorption values greater than 50% were enhanced in the cocaine-ethanol groups compared to the cocaine only groups. Fatal toxicities were only observed in the groups treated with the high cocaine doses (75 mg/kg), with or without ethanol. In these groups, the number of strongly immunoreactive cells had increased significantly compared to the other groups. In the group treated with the high cocaine dose (75 mg/kg) plus ethanol, an increased frequency of late deaths that occurred over 1 h after the drug administration was observed, together with a decreased severity of cocaine-induced seizures and an early enhancement of weakly immunoreactive cells. Unlike the strongly immunoreactive cells, the weakly immunoreactive cells appeared to be continuously enhanced, based on an experiment examining beta-endorphin immunoreactivity at 24 h after an injection of 50 mg/kg cocaine.

Effects of buprenorphine and Ro 15-4513 on delayed death and brain beta-endorphin levels in rats treated with cocaine or cocaine-ethanol

The present study was aimed at elucidating the relationship between brain beta-endorphin, which was estimated by the immunofluorescence method, and fatal drug toxicities due to cocaine and combined cocaine-ethanol administration, including the late fatal toxicities clinically noted. beta-endorphin is an endogenous opioid peptide, and its secretion has been suggested to be influenced by physiological stresses. Furthermore, since protection against these fatal toxicities has been previously reported to be provided by buprenorphine (a ligand for opioid receptors) and Ro 15-4513 (a ligand for benzodiazepine receptors), this study also focused on the relationship between the effects of these two ligands and the changes in brain beta-endorphin immunoreactivity. In the fatal toxicity study, a toxic dose (75 mg/kg, i.p.) of cocaine combined with and without ethanol (3 g/kg, i.p.) was administered to the rats, with and without buprenorphine (0.25, 0.5, 1 mg/kg, i.p.) or Ro 15-4513 (5, 10, 15 mg/kg, i.p.). All of the deaths that occurred in these animals were divided into two groups: early deaths with early toxic symptoms in which the drugs were detected in the tissue samples, and late deaths with late toxic symptoms in which no drugs were detected in the samples. Without the administration of buprenorphine or Ro 15-4513, the frequency of late deaths was higher in the cocaine group as compared to the cocaine-ethanol group. The total mortality rate was effectively attenuated by treatment with 0.25 mg/kg buprenorphine or 10 mg/kg Ro 15-4513. Following treatment with 1 mg/kg buprenorphine or 15 mg/kg Ro 15-4513, the frequency of late deaths was significantly enhanced in the cocaine group. The brain and liver cocaethylene concentrations were also attenuated in those groups in which the total mortality rates were attenuated. In the brain beta-endorphin immunoreactivity study, the number of beta-endorphin immunoreactive nerve cells at the arcuate nucleus was counted at 3 minutes or 24 hours after the drug treatment. At 3 minutes after the drug treatment, the number of weakly immunoreactive cells with photographic light absorption values greater than 50% was enhanced in the groups in which the frequency of late deaths had been increased. In the cocaine-ethanol groups treated with buprenorphine or Ro 15-4513, this enhancement of weakly immunoreactive cells was observed when the total mortality rate was increased, regardless of the type of death. At 24 hours after the drug treatment (50 mg/kg cocaine), an enhancement of the weakly immunoreactive cells only was observed in all of the groups in which the occurrence of toxicities had been enhanced, regardless of the type of toxicity. Therefore, it can be concluded that the enhancement of total brain beta-endorphin immunoreactivity was closely correlated with the increase in the frequency of total fatal toxicities, and that the enhancement of weakly immunoreactive cells was closely correlated with the increase in the frequency of delayed fatal toxicities.

[Suicidal hanging or simulated suicide? Once again a case of Kobue: a spectacular case in the history of Japanese legal medicine]

The cause of death of a 45-year-old woman named Kobue Hiramatsu became an issue in a notable criminal trial called the Kobue-case. The woman and three young girls were found dead in Kobue's house at the end of June 1926. The bodies were decomposed. The three girls had been strangled, while Kobue was found suspended by a waist band tied to a lintel. An open noose had been arranged by winding the band twice around the lintel and tying the both ends. The ligature lay immediately under the chin. Her feet touched the tatami mat and between feet, there were a charcoal brazier and a cutting board. There were two abrasions, not parallel with each other, ont he front of her neck. One abrasion was under the ligature. The other was about 2 cm below the first and was accompanied by bruise. An expert diagnosed that the upper mark without the bruise was produced after death, while the lower abrsion was a ligature mark from strangulation, and that she was suspended for simulation of suicide after being strangled. A former lodger at her house was arrested, but he denied any guilt. The main issue at the trial was the nature of the lower mark and the mechanism by which the two marks were produced. The defendant was found innocent and acquitted based on the expert opinions that the lower mark was a hanging mark and the upper one was produced by the upward movement of the ligature when asphyxia-induced convulsion occurred during hanging. There was no unanimity on how the body weight affected the neck during hanging or what the posture of the body was when convulsion occurred. In the present paper, how Kobue hanged herself and what caused the ligature to move upward is discussed.

Effects of amphetamine on rat embryos developing in vitro

Wistar rat embryos were explanted on Day 10.5 of gestation and exposed in vitro to amphetamine (AMP) at concentrations of 0.1, 0.4, 0.8, 1.2, or 1.6 mM for 24 h, and the direct dysmorphogenic effects of the drug on the embryos were examined by comparisons with a control group. The viability of the cultured embryos was not affected by the AMP treatment. The yolk sac diameter was reduced at AMP concentrations of 1.2 and 1.6 mM. The crown-rump length, the somite number, and the protein content of the embryos were decreased significantly at these two doses, as was the developmental score. The frequency of malformed embryos was increased significantly at the two highest concentrations. The malformations induced in treated embryos included microcephaly, neural tube defects, incomplete rotation of the body axis, and tortuous spinal cord. Abnormal histologic changes, such as derangement and necrosis of the neuroepithelial tissue, were observed in the embryos exposed to the two highest concentrations of the drug. The observed embryotoxic effects appeared to depend on the AMP concentration. Our results demonstrated the direct embryotoxic effects of AMP on rats. The direct dysmorphogenic effect of AMP might be weaker than that of methamphetamine.

A case of disseminated intravascular coagulation probably arising from sudden infant death syndrome

The cause of death in a 45-day-old male infant who was found apneic at home and died 21 hours later was disseminated intravascular coagulation (DIC). The patient was admitted to a hospital in a state of cardio-respiratory arrest. The initial diagnosis was interrupted sudden infant death syndrome. The patient remained apneic, and recurrent discharge of bloody stool was the dominant clinical findings. He died without spontaneous respiration being restored. The autopsy revealed hemorrhages in the lungs and the ventricular septum and the free wall of the left ventricle of the heart. Microscopically, fibrin thrombi were noted in the large intestine and heart. The DIC was probably triggered by a widespread endothelial injury caused by severe hypoxia and acidosis originating from the apnea and cardiac arrest lasting longer than 30 min.

A case of homosexual murder: a victim with testicular regression syndrome

A 25-year-old male was killed with a survival knife by his business and homosexual partner. In addition to 22 wounds on the extremities, 16 wounds were found on the neck, chest and abdomen. The heart and lungs were penetrated, and three wound tracks reached the back of the body. The cause of death was diagnosed as hemorrhage. The genitalia of the victim was anomalous: the pubic hair pattern was that of a female, the penis was small and no testes were identified in the scrotal sac. According to his medical records, micropenis and bilateral cryptorchidism were present at birth, and neither hormonal treatments nor bilateral orchidopexy could enlarge his penis size. At the age of 17, his condition had been diagnosed as hypergonadotropic hypogonadism. His genital anomalies were considered due to embryonic testicular regression syndrome, and his micropenis a possible cause of his homosexual orientation. Judging from the patulous anus with thickened margins, he was probably a passive homosexual. The motive of the murder was not monetary, but rather emotional entanglement. The court judged that the case was one of premeditated murder with a short-circuited motive, and sentenced the defendant to ten years imprisonment.

Isolation and conformational analysis of fragment peptide corresponding to the heparin-binding site of hepatocyte growth factor

Hepatocyte growth factor (HGF) is a potent mitogen for hepatocytes. The mitogenic activity of HGF is mediated by its binding to a high-affinity receptor, c-Met. Heparan sulfate is an initial binding site for HGF, based on its relative abundance on the cell surface. The binding of HGF to heparin or heparin-like molecules may induce oligomerization of HGF and facilitate c-Met-dependent mitogenesis [Zioncheck et al. (1995) J. Biol.Chem. 270, 16871-16878]. Thus, heparin binding is important for the biological activity of HGF. To identify the heparin-binding site of HGF, we isolated fragment peptides corresponding to the site by limited proteolysis and chemical degradation of recombinant human HGF (rhHGF). The heparin-binding ability of the peptides was expressed as their elution positions on heparin-affinity column chromatography with NaCl gradient elution. Because all of the heparin-binding peptides obtained in this study were isolated from the N-terminal hairpin-loop region (PyrGlu32-Asn127) of HGF, the region was identified as the heparin-binding site of HGF. One of the isolated peptides, Phe42-Glu111, containing the N-terminal hairpin-loop structure, was considered a suitable model peptide for the heparin-binding site of HGF. From the observation using circular dichroism spectroscopy, it was indicated that the secondary structure of the peptide changed from a random structure to a beta-sheet-like structure upon heparin binding. In addition, oligomerization of HGF in the presence of heparin was observed by dynamic light scattering. Based on our evidence, it is considered that the conformational change in the heparin-binding site may induce the oligomerization of HGF.

Unusual post-mortem autolytic change in the liver: wavy transformation of hepatocytes

An unusual morphologic change noted in the liver of a 21-year-old male who committed suicide by taking dimenhydrinate is described. The post-mortem interval was two days. Microscopically, there were no marked ante-mortem pathologic changes. In addition to the unusual post-mortem autolytic changes, such as disappearance of the hepatic cords and shrinkage of the hepatocytes, conspicuous way transformation of the hepatocytes, which was apparently never been reported before, was observed. This change could not be identified as an artifact, and it was assessed to be a type of autolysis.

[A case of successful surgical treatment for active endocarditis 2 days after the onset of cerebral infarction]

We performed double valve replacement for a patient with active endocarditis 2 days after the onset of cerebral infarction because of intractable cardiac failure. The use of heparin and the hypotension brought by cardiopulmonary bypass can lead exacerbation of the cerebral symptoms after open heart surgery which is performed during acute phase of cerebral infarction. Perfusion pressure was maintained over 70 mmHg during cardiopulmonary bypass and activated clotting time was kept about 400 seconds to prevent aggravation of cerebral complications in this case. The patients recovered from surgery uneventfully. We described a case who was received double valve replacement 2 days after the onset of cerebral infarction successfully.

Protection against cocaine and combined cocaine-ethanol toxicities in mice by imidazobenzodiazepine Ro 15-4513

The effects of Ro 15-4513 in preventing cocaine and combined cocaine-ethanol toxicities were examined in mice. Ro 15-4513 is a partial inverse agonist of benzodiazepine receptors, which has been implicated in ethanol lethality and cocaine-induced seizures. Ro 15-4513 (5 mg/kg, 10 mg/kg, or 15 mg/kg) was administered intraperitoneally 10 min before the administration of saline and cocaine (75 mg/kg) in the cocaine groups, or before ethanol (3 g/kg) and cocaine (75 mg/kg) in the cocaine-ethanol groups. In both cocaine and cocaine-ethanol groups, two distinct groups of dead animals meeting the same criteria, the IL (immediate lethal) and DL (delayed lethal) groups, could be differentiated, depending on their survival times, observed disorders, and drug levels at the time of death. Differences in the seizure scores further subdivided the two groups. Ro 15-4513 protected mainly against the immediate lethality in the cocaine groups and mainly against the delayed lethality in the cocaine-ethanol groups. The dose of Ro 15-4513 providing the maximal protection against the lethal effects of these drugs was 10 mg/kg in the cocaine groups, and 5 mg/kg in the cocaine-ethanol groups. The sum of the lethalities was still higher with the maximal effective dose of Ro 15-4513 in the cocaine-ethanol groups than in the cocaine groups. In the cocaine-ethanol groups, 5 mg/kg of Ro 15-4513 attenuated both brain and liver cocaethylene levels. Cocaine-induced seizures were also attenuated by any dose of Ro 15-4513 used in the cocaine groups. Although some discrepancies were observed in the protective properties, some validity for the use of Ro 15-4513, a drug with more than one mode of protective action, was demonstrated in this study.

[Putrefaction-induced green discoloration of cadaver skin with circumscribed sparing of areas in contact with tape strips in suicidal asphyxia]

A 67-year-old woman committed suicide by smothering her head tightly in gummed tape. When the body was found, a putrefactive greenish discoloration had spread across the neck, chest and abdomen; but the face was spared. The pale face and the greenish trunk caused a striking contrast. This distribution pattern of discoloration was produced by the gummed tape, which smothered the head and prevented the formation of sulfhemoglobin by blocking entry of ambient oxygen into the skin.

Grazing bullet wounds on the tongue and liver

A 59-year-old man was shot at the wheel of his car while waiting for a traffic light at an intersection. He was shot through the windshield from a distance of about 1 m. He was pronounced dead on arrival at an emergency hospital. X-ray photographs taken there demonstrated the presence of three bullets within the body. The murder weapon was found to be a thirty-eight caliber revolver. In all, five bullet wounds were recognized, one was located in the right side of the neck, one in the lower part of the left temple, and three on the right side of the body. The wound in the right neck was an entrance bullet wound. The bullet had exited at the left temple, after glancing on the root of the tongue. The three wounds on the right side of the body were all entrance bullet wounds. The fatal bullet entered the right chest cavity at the 7th intercostal space and lacerated the right lung and the ascending aorta after glancing on the right lobe of the liver. The cause of death was hemorrhage from the lacerated aorta. The grazing bullet wounds of the tongue and liver were shallow defects of the tissues with irregular margins.

Effects of postnatal cocaine on differentiation of the rat corpus callosum

We investigated the effects of cocaine on the development of the corpus callosum. Pregnant Wistar strain rats (Thirteenth day of gestation) were used in this study. On the day following birth, litters were culled to 8 pups (4 males and 4 females), and rats were assigned to either a control or drug treatment group. From postnatal day 1 (P1, at birth = P0) to P5, cocaine (50 mg/kg) was subcutaneously injected to the cocaine-treated pups, and saline in the same volume to the control pups. Animals were sacrificed in 110 days and a mid-sagittal section of the callosum was obtained. From this section the morphometric measurement of the corpus callosum was performed. In the control group the rat corpus callosum has a sex difference with the male corpus callosum being larger than the female's. But this sex difference disappeared in the cocaine group. This was attributed to the fact that cocaine-treated male rats indicated a significant reduction of callosal area. These findings suggest that the early postnatal cocaine can abolish the sexual differentiation of the corpus callosum.

Protective effects of buprenorphine against amplified cocaine and ethanol lethality in mice: role of cocaethylene

The lethal effects of combining cocaine and ethanol administration in mice and the protective effects of buprenorphine, a mixed opioid agonist-antagonist, were examined with consideration to the involvement of cocaethylene. In Experiment 1, buprenorphine (0.25 or 0.5 mg/kg, i.p.) protected against a dose of cocaine exceeding the LD50 value (75 mg/kg, i.p.) combined with ethanol (3 g/kg, i.p.), although this attenuated lethality was not lower than the non-ethanol group (acute administration experiment). In Experiment 2, daily administrations of non-lethal doses of cocaine (40 mg/kg, i.p.) were combined with ethanol (1.5 g/kg, i.p.) for up to 5 days (repeated administration experiment). In Experiment 3, one dose of cocaine (75 mg/kg, i.p.) was administered after the ad libitum ingestion of an ethanol liquid diet, created by replacing 35% of the total calories with ethanol, for five days (ethanol liquid diet experiment). In all three experiments, 2 lethal groups could be discerned: an immediate lethal group (IL group) and a delayed lethal group (DL group). These groups were differentiated based on their survival times after the cocaine administrations, observed respiratory and locomotive disorders, and drug concentrations. The number of the DL group animals were elevated only in the combined cocaine-ethanol groups of Experiment 1. Buprenorphine (0.25 mg/kg, i.p.) administered before each cocaine injection attenuated the total percent lethality to levels not higher than the total percent lethality of the non-ethanol groups in the latter two experiments. This supports the validity of the protective effects of buprenorphine on cocaine toxicity amplified by non-lethal doses of ethanol. Quantitative postmortem drug analyses of mice from the IL groups, in which the drug levels were high enough to be determined, suggested that buprenorphine had a protective effect against combined cocaine-ethanol lethality without significantly decreasing the drug distributions, except for the concentration of cocaethylene in the brain.

Death caused by undiagnosed acute pancreatitis

A fatal case of acute pancreatitis is reported. On account of difficulty in eating caused by persistent dysphagia and heartburn, the clinical condition of a 39-year-old man who had been a heavy drinker deteriorated rapidly. He was taken to a hospital in an ambulance in an unconscious state. Based on the endoscopic examination and blood chemistry data, the diagnosis of hemorrhagic esophagitis and hepatic failure was made. Treatment including fluid infusion was unsuccessful and he died on the second hospital day. Based on a strong suspicion that the pathologic change in the esophagus may have been chemical esophagitis caused by corrosives of some type, the police ordered an administrative autopsy. The postmortem examination revealed marked necrosis in the pancreas and in the abdominal fatty tissue including the omentum and the mesentery. The necrotic areas in the pancreas were accompanied by only a slight degree of hemorrhage. The cause of death was diagnosed as acute pancreatitis. The pathologic change in the esophagus was identified as Candida esophagitis. Alcohol abuse and malnutrition caused by esophagitis were both considered to be factors which lead to the acute fatal pancreatitis.

Role of brain cocaethylene levels in combined cocaine-ethanol lethality in mice

The purpose of this study was to examine the lethal effects of combining cocaine with ethanol in mice by assaying for cocaethylene at the time of death. After the voluntary oral ingestion of ethanol in the form of a liquid diet containing 35% ethanol-derived calories for 5 days, intraperitoneal cocaine (60 mg/kg) was administered daily for up to 5 days while the ethanol diet continued (ethanol diet group). The mice in the ethanol diet group were paired with control mice that received a control liquid diet containing equivalent carbohydrate calories in the form of sucrose instead of ethanol (control diet group). In order to analyze the drugs, samples (blood, liver and brain) were collected for both groups from the dead animals that could not tolerate the 5 days of cocaine administration. A higher rate of lethality was observed in the ethanol diet group as compared to the control diet group. Furthermore, various patterns of cocaine lethality were revealed under different conditions of ethanol intake. According to the survival times after the last cocaine administration, observed respiratory and locomotive disorders, and drug concentrations, a total of 5 subgroups in the ethanol diet group (Groups E1-E5) and a total of 3 subgroups in the control diet group (Groups C1-C3) were differentiated. The ratio of the mean cocaethylene concentration relative to the mean cocaine concentration was over 30% in the livers of animals in an earliest lethal subgroup (Group E1). In addition, examination of all of the dead animals in the ethanol diet group revealed the prolonged presence of cocaethylene in the brain of the mice that died within 2 hours. Thus, it was suggested that cocaethylene has strong effects on the brain receptors and influences cocaine lethality.

Autopsy cases among patients with mental disorders: an unusual case of asphyxia caused by the iron roller of a garbage truck

A case of asphyxia of a young man suffering from "Identity Disorder" as delineated by the DSM-III-R (American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders revised in 1987) is reported. The patient jumped into the drum of a garbage truck and the iron roller in the drum asphyxiated him by compression. In addition to the presentation of this rare category of the DSM-III-R disorders as an autopsy case and an unusual means of asphyxia, we briefly reviewed other autopsy cases of the patients with mental disorders who died in Japan between 1988 and 1992.

[A technique for removal of entrapped intra-aortic balloon catheter through the left axillary artery]

A case of intra-aortic balloon pumping (IABP) entrapment in which the ruptured catheter could be removed through the left axillary artery was reported. A 68-year-old man was admitted with persistent chest pain, and because of his poor cardiac condition, an IAB catheter was inserted by the Seldinger technique. During attempted extraction of the IAB catheter resistance was encountered and it turned out to be entrapped. Then a guide-wire was passed through the IAB lumen to the left axillary artery, the artery was exposed, and the tip of the guide-wire and IAB catheter were led to the arteriotomy site. After the balloon was dissected, the IAB catheter could be removed through the axillary artery. Finally, left femoro-left branchial artery bypass was performed with e-PTFE graft because of the arterial injury and ischemia of the involved arm. The patient recovered from this episode.

[Homicide by strangulation with a lasso sling]

A 50-year-old physically handicapped man was found dead on his wheelchair in a short passage on the ground floor of a high-rise housing development. The lattice doors at the both ends of the passage were closed and the wheelchair with the body was found at the door to an adjoining indoor parking place for bicycles. A noose of a vinyl plastic cord was found wound around the neck; the other end of the cord was tied through the lattice door to a handrail on the wall of the parking place. The wheelchair was stopped sideways; its chair back was in contact with a doorpost. The body which was slipped from the seat of the wheelchair was incompletely suspended by the noose. The cause of death primarily was diagnosed as hanging. The police suspected murder and arrested a 21-year-old male assailant. According to his confession, the assailant pushed the wheelchair through the lattice door in the passage, stopped it at the door and braked it. Immediately thereafter he returned to the parking place and locked the lattice door behind him. After having made a kind of lasso using a cord taken off from a bicycle which has been sitting there, he reached out his hands through the lattice door and lassoed the man on the wheelchair from behind. Finally, he tied another end of the lasso to the handrail. It was considered that the body of the victim was slipped down in the stage of convulsion and incompletely suspended by the noose.

Nuclear magnetic resonance study and secondary structure determination of the antibiotic peptide, aibellin

Aibellin is a 20-residue peptide antibiotic that has been isolated from the fungus Verticimonosporium ellipticum. Sequence-specific assignment of the 1H- and 13C-NMR signals of aibellin in a methanol solution was achieved by using the two-dimensional NMR technique. Furthermore, its secondary structure was characterized by circular dichroism (CD) and NOESY spectra. The observed NOEs, 3JNHC alpha H coupling constants and amide hydrogen-deuterium (H-D) exchange rates show that the peptide consisted of two alpha-helices and a bent structure around a Pro-14 residue.

[An unusual case of extensive cadaver ingestion by a domestic dog]

There are only a few reports on cases in which the body of a human who died unnoticed in a house was destructed by a dog. The presented case seems to be unusual in that the extent of destruction was severe and the distribution of injuries was different from that reported in the literature. A 59-year-old man was found dead naked in a room, the cause of death being ischemic heart disease. The lower part of the body was lying in a so-called kotatsu. Wounds were confined to the upper part of the body. The head was skeletonized. The anterior thorax was missing. What was different in our case from previous ones was that the genitals were spared from destruction; the kotatsu frame may have prevented the dog from approaching this region. The extensive destruction within the short period of about 3 days may be explained by the fact that the victim was naked when he died.

Sudden and unexpected death due to undiagnosed pulmonary thromboembolism in an adolescent male without previous history of trauma

We report a case of sudden death in a 19-year-old adolescent male who had been receiving hospital treatment because of a persistent right calf pain which had started about 18 days previously. The pain had not been relieved by analgesics, and had extended to the right thigh. The post-mortem examination revealed that the cause of death was pulmonary embolism by thrombi which had arisen in the right calf veins. The bilateral pulmonary arteries were packed with thrombi, and many pulmonary branches were occluded with fresh thrombi. The right calf veins contained thrombi of differing ages. In old thrombi, massive collagen formation and hemosiderin granules were present but elastic fibers had not yet formed. Therefore, it was considered that the old thrombi had formed at the time of the patient's first visit to the hospital. The right calf pain for which the deceased had sought medical advice was considered to have been caused by the vein thrombosis. Although various risk factors for the formation of thrombi are known, in the present case no precedent causes other than obesity were identified.