Power suppression in EEG after the onset of SAH is a significant marker of early brain injury in rat models

We analyzed the correlation between the duration of electroencephalogram (EEG) recovery and histological outcome in rats in the acute stage of subarachnoid hemorrhage (SAH) to find a new predictor of the subsequent outcome. SAH was induced in eight rats by cisternal blood injection, and the duration of cortical depolarization was measured. EEG power spectrums were given by time frequency analysis, and histology was evaluated. The appropriate frequency band and recovery percentage of EEG (defined as EEG recovery time) to predict the neuronal damage were determined from 25 patterns (5 bands × 5 recovery rates) of receiver operating characteristic (ROC) curves. Probit regression curves were depicted to evaluate the relationships between neuronal injury and duration of depolarization and EEG recovery. The optimal values of the EEG band and the EEG recovery time to predict neuronal damage were 10-15 Hz and 40%, respectively (area under the curve [AUC]: 0.97). There was a close relationship between the percentage of damaged neurons and the duration of depolarization or EEG recovery time. These results suggest that EEG recovery time, under the above frequency band and recovery rate, may be a novel marker to predict the outcome after SAH.

Cardiopulmonary Resuscitation May Not Stop Glutamate Release in the Cerebral Cortex

BACKGROUND

Cardiopulmonary resuscitation (CPR) may not be sufficient to halt the progression of brain damage. Using extracellular glutamate concentration as a marker for neuronal damage, we quantitatively evaluated the degree of brain damage during resuscitation without return of spontaneous circulation.

MATERIALS AND METHODS

Extracellular cerebral glutamate concentration was measured with a microdialysis probe every 2 minutes for 40 minutes after electrical stimulation-induced cardiac arrest without return of spontaneous circulation in Sprague-Dawley rats. The rats were divided into 3 groups (7 per group) according to the treatment received during the 40 minutes observation period: mechanical ventilation without chest compression (group V); mechanical ventilation and chest compression (group VC) and; ventilation, chest compression and brain hypothermia (group VCH). Chest compression (20 min) and hypothermia (40 min) were initiated 6 minutes after the onset of cardiac arrest.

RESULTS

Glutamate concentration increased in all groups after cardiac arrest. Although after the onset of chest compression, glutamate concentration showed a significant difference at 2 min and reached the maximum at 6 min (VC group; 284±48 μmol/L vs. V group 398±126 μmol/L, P =0.003), there was no difference toward the end of chest compression (513±61 μmol/L vs. 588±103 μmol/L, P =0.051). In the VCH group, the initial increase in glutamate concentration was suddenly suppressed 2 minutes after the onset of brain hypothermia.

CONCLUSIONS

CPR alone reduced the progression of brain damage for a limited period but CPR in combination with brain cooling strongly suppressed increases in glutamate levels.

Incidence and clinical characteristics of spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan

OBJECTIVE

There have been no accurate surveillance data regarding the incidence rate of spinal arteriovenous shunts (SAVSs). Here, the authors investigate the epidemiology and clinical characteristics of SAVSs.

METHODS

The authors conducted multicenter hospital-based surveillance as an inventory survey at 8 core hospitals in Okayama Prefecture between April 1, 2009, and March 31, 2019. Consecutive patients who lived in Okayama and were diagnosed with SAVSs on angiographic studies were enrolled. The clinical characteristics and the incidence rates of each form of SAVS and the differences between SAVSs at different spinal levels were analyzed.

RESULTS

The authors identified a total of 45 patients with SAVSs, including 2 cases of spinal arteriovenous malformation, 5 cases of perimedullary arteriovenous fistula (AVF), 31 cases of spinal dural AVF (SDAVF), and 7 cases of spinal epidural AVF (SEAVF). The crude incidence rate was 0.234 per 100,000 person-years for all SAVSs including those at the craniocervical junction (CCJ) level. The incidence rate of SDAVF and SEAVF combined increased with advancing age in men only. In a comparative analysis between upper and lower spinal SDAVF/SEAVF, hemorrhage occurred in 7/14 cases (50%) at the CCJ/cervical level and in 0/24 cases (0%) at the thoracolumbar level (p = 0.0003). Venous congestion appeared in 1/14 cases (7%) at the CCJ/cervical level and in 23/24 cases (96%) at the thoracolumbar level (p < 0.0001).

CONCLUSIONS

The authors reported detailed incidence rates of SAVSs in Japan. There were some differences in clinical characteristics of SAVSs in the upper spinal levels and those in the lower spinal levels.

Trends in Incidence of Intracranial and Spinal Arteriovenous Shunts: Hospital-Based Surveillance in Okayama, Japan

BACKGROUND AND PURPOSE

To date, the incidence of intracranial and spinal arteriovenous shunts has not been thoroughly investigated. We aimed to clarify recent trends in the rates of intracranial and spinal arteriovenous shunts in Japan.

METHODS

We conducted multicenter hospital-based surveillance at 8 core hospitals in Okayama Prefecture between April 1, 2009 and March 31, 2019. Patients who lived in Okayama and were diagnosed with cerebral arteriovenous malformations, dural arteriovenous fistulas (DAVFs), or spinal arteriovenous shunts (SAVSs) were enrolled. The incidence and temporal trends of each disease were calculated.

RESULTS

Among a total of 393 cranial and spinal arteriovenous shunts, 201 (51.1%) cases of DAVF, 155 (39.4%) cases of cerebral arteriovenous malformation, and 34 (8.7%) cases of SAVS were identified. The crude incidence rates between 2009 and 2019 were 2.040 per 100 000 person-years for all arteriovenous shunts, 0.805 for cerebral arteriovenous malformation, 1.044 for DAVF, and 0.177 for SAVS. The incidence of all types tended to increase over the decade, with a notable increase in incidence starting in 2012. Even after adjusting for population aging, the incidence of nonaggressive DAVF increased 6.0-fold while that of SAVS increased 4.4-fold from 2010 to 2018.

CONCLUSIONS

In contrast to previous studies, we found that the incidence of DAVF is higher than that of cerebral arteriovenous malformation. Even after adjusting for population aging, all of the disease types tended to increase in incidence over the last decade, with an especially prominent increase in SAVSs and nonaggressive DAVFs. Various factors including population aging may affect an increase in DAVF and SAVS.

4-Hydroxyl-2-Nonenal Localized Expression Pattern in Retrieved Clots is Associated with Large Artery Atherosclerosis in Stroke Patients

OBJECTIVES

The relationship between stroke etiology and clot pathology remains controversial.

MATERIALS AND METHODS

We performed histological analysis of clots retrieved from 52 acute ischemic stroke patients using hematoxylin and eosin staining and immunohistochemistry (CD42b and oxidative/hypoxic stress markers). The correlations between clot composition and the stroke etiological group (i.e., cardioembolic, cryptogenic, or large artery atherosclerosis) were assessed.

RESULTS

Of the 52 clots analyzed, there were no significant differences in histopathologic composition (e.g., white blood cells, red blood cells, fibrin, and platelets) between the 3 etiological groups (P = .92). By contrast, all large artery atherosclerosis clots showed a localized pattern with the oxidative stress marker 4-hydroxyl-2-nonenal (P < .01). From all 52 clots, 4-hydroxyl-2-nonenal expression patterns were localized in 28.8% of clots, diffuse in 57.7% of clots, and no signal in 13.5% of clots.

CONCLUSIONS

A localized pattern of 4-hydroxyl-2-nonenal staining may be a novel and effective marker for large artery atherosclerosis (sensitivity 100%, specificity 82%).

A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom an Approach through the Jugular Venous Arch Involving Facial Vein Return Was Adopted

Objective

We report the case of a cavernous sinus dural arteriovenous fistula (CSdAVF) treated by transvenous embolization (TVE) via the jugular venous arch (JVA) connecting bilateral superficial cervical veins.

Case Presentation

A male patient in his 50s presenting with diplopia and headache was diagnosed with a CSdAVF. The first session of TVE resulted in incomplete obliteration of the fistula due to poor accessibility through the inferior petrosal sinus (IPS), and postoperative computed tomography angiography (CTA) disclosed a newly developed drainage route into the facial vein (FV) connecting to the anterior jugular vein (AJV) and the JVA. The patient underwent the second session of TVE through the JVA, FV, and the superior ophthalmic vein (SOV), and obliteration was achieved.

Conclusion

There is a considerable variation in the anatomy of facio-cervical veins in patients with CSdAVF. Meticulous preoperative evaluation of the venous drainage route using modern diagnostic tools is indispensable to achieve successful results in patients with CSdAVF.

Combined gene therapy with vascular endothelial growth factor plus apelin in a chronic cerebral hypoperfusion model in rats

OBJECTIVE

The aim of this study was to evaluate whether combined gene therapy with vascular endothelial growth factor (VEGF) plus apelin during indirect vasoreconstructive surgery enhances brain angiogenesis in a chronic cerebral hypoperfusion model in rats.

METHODS

A chronic cerebral hypoperfusion model induced by the permanent ligation of bilateral common carotid arteries (CCAs; a procedure herein referred to as “CCA occlusion” [CCAO]) in rats was employed in this study. Seven days after the CCAO procedure, the authors performed encephalo-myo-synangiosis (EMS) and injected plasmid(s) into each rat's temporal muscle. Rats were divided into 4 groups based on which plasmid was received (i.e., LacZ group, VEGF group, apelin group, and VEGF+apelin group). Protein levels in the cortex and attached muscle were assessed with enzyme-linked immunosorbent assay (ELISA) on Day 7 after EMS, while immunofluorescent analysis of cortical vessels was performed on Day 14 after EMS.

RESULTS

The total number of blood vessels in the cortex on Day 14 after EMS was significantly larger in the VEGF group and the VEGF+apelin group than in the LacZ group (p < 0.05, respectively). Larger vessels appeared in the VEGF+apelin group than in the other groups (p < 0.05, respectively). Apelin protein on Day 7 after EMS was not detected in the cortex for any of the groups. In the attached muscle, apelin protein was detected only in the apelin group and the VEGF+apelin group. Immunofluorescent analysis revealed that apelin and its receptor, APJ, were expressed on endothelial cells (ECs) 7 days after the CCAO.

CONCLUSIONS

Combined gene therapy (VEGF plus apelin) during EMS in a chronic cerebral hypoperfusion model can enhance angiogenesis in rats. This treatment has the potential to be a feasible option in a clinical setting for patients with moyamoya disease.

NADH fluorescence imaging and the histological impact of cortical spreading depolarization during the acute phase of subarachnoid hemorrhage in rats

OBJECTIVE Although cortical spreading depolarization (CSD) has been observed during the early phase of subarachnoid hemorrhage (SAH) in clinical settings, the pathogenicity of CSD is unclear. The aim of this study is to elucidate the effects of loss of membrane potential on neuronal damage during the acute phase of SAH. METHODS Twenty-four rats were subjected to SAH by the perforation method. The propagation of depolarization in the brain cortex was examined by using electrodes to monitor 2 direct-current (DC) potentials and obtaining NADH (reduced nicotinamide adenine dinucleotide) fluorescence images while exposing the parietal-temporal cortex to ultraviolet light. Cerebral blood flow (CBF) was monitored in the vicinity of the lateral electrode. Twenty-four hours after onset of SAH, histological damage was evaluated at the DC potential recording sites. RESULTS Changes in DC potentials (n = 48 in total) were sorted into 3 types according to the appearance of ischemic depolarization in the entire hemisphere following induction of SAH. In Type 1 changes (n = 21), ischemic depolarization was not observed during a 1-hour observation period. In Type 2 changes (n = 13), the DC potential demonstrated ischemic depolarization on initiation of SAH and recovered 80% from the maximal DC deflection during a 1-hour observation period (33.3 ± 15.8 minutes). In Type 3 changes (n = 14), the DC potential displayed ischemic depolarization and did not recover during a 1-hour observation period. Histological evaluations at DC potential recording sites showed intact tissue at all sites in the Type 1 group, whereas in the Type 2 and Type 3 groups neuronal damage of varying severity was observed depending on the duration of ischemic depolarization. The duration of depolarization that causes injury to 50% of neurons (P₅₀) was estimated to be 22.4 minutes (95% confidence intervals 17.0-30.3 minutes). CSD was observed in 3 rats at 6 sites in the Type 1 group 5.1 ± 2.2 minutes after initiation of SAH. On NADH fluorescence images CSD was initially observed in the anterior cortex; it propagated through the entire hemisphere in the direction of the occipital cortex at a rate of 3 mm/minute, with repolarization in 2.3 ± 1.2 minutes. DC potential recording sites that had undergone CSD were found to have intact tissue 24 hours later. Compared with depolarization that caused 50% neuronal damage, the duration of CSD was too short to cause histological damage. CONCLUSIONS CSD was successfully visualized using NADH fluorescence. It propagated from the anterior to the posterior cortex along with an increase in CBF. The duration of depolarization in CSD (2.3 ± 1.2 minutes) was far shorter than that causing 50% neuronal damage (22.4 minutes) and was not associated with histological damage in the current experimental setting.

[A Case of Traumatic Vertebral Arteriovenous Fistula Treated by Internal Trapping of the Vertebral Artery]

BACKGROUND

Traumatic vertebral arteriovenous fistula (TVAVF) is an uncommon disease that occurs after traumatic injury. Here we report a case of TVAVF presenting with cervical bruit successfully treated by internal trapping using coils.

CASE PRESENTATION

A 66-year-old man was transferred to our hospital after falling into a ditch. Initial CT revealed a C2 fracture into the right transverse foramen, and the patient had been treated with conservative management. A vascular abnormality was suspected because the patient exhibited cervical bruit on admission. CT angiography revealed right TVAVF at the V2 segment of the right vertebral artery (VA) near the C2 fracture. Digital subtraction angiography also revealed right TVAVF between the V2 segment of the right VA and the vertebral venous plexus, draining into the right internal jugular vein and the deep cervical vein as well as the intracranial venous system. The fistula was also opacified by retrograde flow from the contralateral VA through the union, while the flow in the basilar artery was antegrade. The patient was diagnosed with TVAVF with large transection of the right VA, and underwent endovascular treatment with internal trapping of the right VA using coils starting distal to the transection and proceeding in a proximal direction. After treatment, the right VAVF and right VA were completely occluded. The patient achieved clinical symptom resolution with no neurological deficits.

CONCLUSION

Endovascular treatment with internal trapping of the VA using coils is safe and effective against TVAVF.

Search for antihelium with the BESS-Polar spectrometer

In two long-duration balloon flights over Antarctica, the Balloon-borne Experiment with a Superconducting Spectrometer (BESS) collaboration has searched for antihelium in the cosmic radiation with the highest sensitivity reported. BESS-Polar I flew in 2004, observing for 8.5 days. BESS-Polar II flew in 2007-2008, observing for 24.5 days. No antihelium candidate was found in BESS-Polar I data among 8.4×10(6) |Z|=2 nuclei from 1.0 to 20 GV or in BESS-Polar II data among 4.0×10(7) |Z|=2 nuclei from 1.0 to 14 GV. Assuming antihelium to have the same spectral shape as helium, a 95% confidence upper limit to the possible abundance of antihelium relative to helium of 6.9×10(-8)} was determined combining all BESS data, including the two BESS-Polar flights. With no assumed antihelium spectrum and a weighted average of the lowest antihelium efficiencies for each flight, an upper limit of 1.0×10(-7) from 1.6 to 14 GV was determined for the combined BESS-Polar data. Under both antihelium spectral assumptions, these are the lowest limits obtained to date.

[Sequential changes in haemostatic activity during prolonged surgery and its alteration with continuous heparin infusion]

We measured molecular markers to study sequential changes in the hemostatic activity and its alteration by intraoperative continuous heparin infusion in patients, undergoing surgeries of 10 hours or longer for oral cancers. The heparin was infused continuously from the beginning of microsurgery until the end of anaesthesia to maintain an activated partial thromboplastin time between 50 to 70 seconds in the heparin group. In the control group, the concentrations of thrombin-antithrombin III complex (TAT), fragment 1 + 2 (F1 + 2) and D-dimer increased, and the soluble fibrin monomer complex (SFMC) became positive 2-6 hours after the induction of anesthesia. With continuous heparinization, the changes in measured molecular markers were clearly inhibited compared with the control group. The hemostatic activities increased progressively from the early stages of surgery, and the intraoperative continuous heparin infusion was effective in suppressing the hypercoagulable state during prolonged surgery.

Efficacy of influenza vaccine in the elderly: reduction in risks of mortality and morbidity during an influenza A (H3N2) epidemic for the elderly in nursing homes

The effect of influenza vaccination on the occurrence and severity of influenza virus infection in elderly nursing home residents was studied during an influenza A (H3N2) epidemic in Japan. Of 22,462 individuals living in 301 welfare nursing homes, 10,739 received inactivated (subunit) influenza vaccine. Through the period November 1998 to March 1999, there were 950 cases of influenza infection diagnosed clinically, with virus isolation and/or serology. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection, and deaths due to influenza in the vaccinated cohort compared with the unvaccinated controls. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is safe and effective in this population, and should be an integral part of the routine care of persons aged 65 years and over residing in nursing homes.

Vaccine effectiveness for influenza in the elderly in welfare nursing homes during an influenza A (H3N2) epidemic

Influenza vaccine effect on the occurrence and severity of influenza virus infection in a population residing in nursing homes for the elderly was studied as a cohort study during an influenza A (H3N2) epidemic in Japan. Of 22,462 individuals living in 301 welfare nursing homes, 10,739 voluntarily received inactivated, sub-unit trivalent influenza vaccine in a programme supported by the Osaka Prefectural Government. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection, and deaths due to influenza in the vaccinated cohort compared to the unvaccinated controls. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is effective for preventing influenza disease in persons aged 65 years and over, and should be an integral part of the care of this population residing in nursing homes.

Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen

The conventional inferior alveolar nerve block (conventional technique) has potential risks of neural and vascular injuries. We studied a method of inferior alveolar nerve block by injecting a local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique) with the purpose of avoiding such complications. The insertion angle of the anterior technique and the estimation of anesthesia in the anterior technique were examined. The predicted insertion angle measured on computed tomographic images was 60.1 +/- 7.1 degrees from the median, with the syringe end lying on the contralateral mandibular first molar, and the insertion depth was approximately 10 mm. We applied the anterior technique to 100 patients for mandibular molar extraction and assessed the anesthetic effects. A success rate of 74% was obtained. This is similar to that reported for the conventional technique but without the accompanying risks for inferior alveolar neural and vascular complications.

Inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen: radiographic study of local anesthetic spread in the pterygomandibular space

We studied the spread of local anesthetic solution in the inferior alveolar nerve block by the injection of local anesthetic solution into the pterygomandibular space anterior to the mandibular foramen (anterior technique). Seventeen volunteers were injected with 1.8 mL of a mixture containing lidocaine and contrast medium utilizing the anterior technique. The course of spread was traced by fluoroscopy in the sagittal plane, and the distribution area was evaluated by lateral cephalograms and horizontal computed tomography. The results indicate that the contrast medium mixture spreads rapidly in the pterygomandibular space to the inferior alveolar nerve in the subjects who exhibited inferior alveolar nerve block effect. We concluded that the anesthetic effect due to the anterior technique was produced by the rapid distribution of anesthetic solution in the pterygomandibular space toward the mandibular foramen, and individual differences in the time of onset of analgesia may be due to differences in the histologic perineural tissues.

Blood coagulation activity during microsurgery

The authors investigated blood coagulation activity in patients who underwent microsurgery. Hemostatic parameters were measured in 9 patients (10 operations) who were undergoing free tissue transfers. These parameters included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinopeptide A (FPA), prothrombin fragment 1 + 2 (F1 + 2), and thrombin-antithrombin complex (TAT). The flap totally necrosed owing to vasospasm in 1 patient with osteomyelitis of the heel, and the FPA, F1 + 2, and TAT values significantly increased. Reexploration was required because of flap cyanosis in 1 patient with a hemangioma on the wrist, and the F1 + 2 and TAT values increased during the salvage procedure. These molecular markers could be important in indicating hypercoagulable state sensitivity, and they serve as a warning of possible vascular compromise to a surgeon.

[Intracystic infusion therapy of minocycline hydrochloride for benign hepatic cysts]

This paper describes ultrasonically-guided infusion of minocycline hydrochloride solution (MINO infusion therapy) in benign nonparasitic cysts of the liver. MINO infusion therapy was performed in 7 large hepatic cysts and successful results were obtained in 6 lesions. The infusion procedure in the initial 4 hepatic cysts a 7 Fr catheter was placed into the cyst and MINO solution was left in the cyst according to the procedure of ethanol infusion therapy. In the most recent 2 cases the cyst was punctured with a 21G needle, washed with physiologic saline and then infused MINO solution without placement of an indwelling drainage tube. This modified procedure is simple and safe and also yields a good therapeutic result. MINO infusion therapy for benign hepatic cyst is very useful and the modified procedure can be performed safely in elderly patients and in patients with several complications.

Disseminated intravascular coagulation in a patient with acute myeloid leukemia. Ultrastructural evidence of hypercoagulation in bone marrow

The bone marrow of a 53-year-old woman with acute myeloid leukemia (AML) with disseminated intravascular coagulation was investigated by transmission electron microscopy. The patient had a preceding granulocytic sarcoma, and subclinical disseminated intravascular coagulation occurred concomitantly with the development of AML. Ultrastructural findings of the bone marrow at the onset of AML revealed the following: (1) The cytoplasm of the leukemic cells showed frequent fragmentation, resulting in the formation of abundant cytoplasmic fragments. (2) These cytoplasmic fragments were surrounded by abundant fibrin fibers, forming the fibrin-cytoplasmic fragment complex (FCF complex). (3) Slight fibrin deposition was seen around the leukemic cells and in the intercellular space of the bone marrow. Fibrin deposition in the bone marrow is thought to represent morphologic evidence of disseminated intravascular coagulation. The damage on the leukemic cell surface due to the cytoplasmic fragmentation seems to be closely related to the development of disseminated intravascular coagulation.

[Arteriosclerosis obliterans that was improved by LDL apheresis]

We reported here a case of arteriosclerosis obliterans (ASO) in which clinical symptoms and signs were improved after repeated LDL apheresis. The patient was a 70-year-old man who was diagnosed as having ASO in 1989. Although drug treatment started for the arterial disease, such clinical manifestations as rubor and intermittent claudication were gradually worsening. In 1991, the patient was also found to have diabetes mellitus (DM), leading to admission for its treatment. Insulin therapy was initially required, but it finally became possible to maintain a good control of DM with diet therapy alone. Since hypercholesterolemia (402 mg/dl) was noted on admission, we began to give the patient pravastatin. In response to the medication, serum total cholesterol (TC) levels declined to 270 mg/dl, but no further improvement was obtained. We therefore decided to perform LDL apheresis on the patient, hoping the improvement of both ASO and hypercholesterolemia. After six series of LDL apheresis were performed during 4 weeks, ASO-related signs and symptoms (i. e., intermittent claudication) were remarkably improved, and serum TC levels were decreased below 200 mg/dl. Our experience in the present case suggested that this procedure would be useful as an effective choice of treatment for ASO, but further studies as to the indication and protocol of this therapeutic maneuver will be clearly needed.

Evidence that gastric antisecretory action of lipopolysaccharide is not due to a toxic effect on gastric parietal cells

We have recently found that bacterial lipopolysaccharide (LPS) or endotoxin at minute doses inhibits the secretion of gastric acid and pepsin in rats. The present study was performed to determine whether this antisecretory action of LPS was a reversible biological response or a result of the destruction of gastric parietal cells by endotoxin. The intraperitoneal injection of LPS into pylorus-ligated rats resulted in a dose-related (40-4000 ng/kg) decrease in gastric acid secretion, with maximal inhibition being observed at a dose of 4000 ng/kg. The stomach then was examined both macroscopically and microscopically for the presence or absence of mucosal lesions or damaged gastric parietal cells. No morphological changes in the gastric mucosal structure including parietal cells were observed even in the rats injected with 4000 ng/kg of LPS. Next, basal gastric acid output was compared in the rats that had received LPS (4000 ng/kg, intraperitoneal) or saline alone 24 hr before. There was no significant difference in gastric acid secretion between the saline- and LPS-pretreated groups, indicating that the secretory capacity of gastric parietal cells returned to the control level at 24 hr after the injection of a maximal antisecretory dose of LPS. These results clearly suggest that the LPS-induced inhibition of gastric secretion results not from its toxic or destructive effect on the gastric secretory mechanism but from its reversible biological effect on gastric physiology.

The gastric antisecretory action of lipopolysaccharide is blocked by indomethacin

We have recently found that bacterial lipopolysaccharide (LPS) at minute doses inhibits the secretion of gastric acid and pepsin in rats. The present study was performed to examine the mechanism by which LPS exerts its antisecretory action. The i.p. injection of LPS resulted in a dose-dependent (40-4000 ng/kg) decrease in gastric acid output in pylorus-ligated rats. However, preinjection of indomethacin (2-10 mg/kg s.c.), an inhibitor of prostaglandin biosynthesis, prevented the LPS-induced inhibition of gastric secretion in a dose-related manner, while these concentrations of indomethacin by themselves did not affect gastric acid output. These results suggest that LPS requires an intact prostaglandin system to exhibit its inhibitory action on gastric secretion.

Characterization of secretory responses in exocrine pancreas of genetically obese Zucker rats

Secretory responses of the exocrine pancreas in the obese Zucker rat with an inherited genetic disorder were compared with those in lean control rats. Amylase concentration in pancreatic acinar cells of obese rats was reduced to 62% of the control value, whereas trypsinogen concentration was increased to 269%. The activity ratio of amylase to trypsinogen in the pancreatic acini of obese rats was about one-fourth of that in controls. The activity ratio of amylase to trypsinogen in pancreatic juice released by stimulation with varying concentrations of CCK8 or carbachol in the obese rats was also reduced to one-fourth of that in control rats. The concentration of the secretagogs inducing half-maximal secretory responses (EC50) in the obese rats was almost identical to that in the controls. The downward shift of the dose-response relation for these secretagogs in the acini of obese rats was analogous to that in streptozotocin-induced diabetic rats, cold-exposed rats, or lactating rats, as demonstrated previously. The present results may be explained by the changes in enzyme content and secretory responses found in pancreatic acini of obese Zucker rats, which would be attributable mainly to congenital disturbance in "insulo-acinar axis."

Central basic fibroblast growth factor inhibits gastric ulcer formation in rats

We have recently reported that basic fibroblast growth factor (bFGF) acts in the brain to inhibit the secretion of gastric acid and pepsin, two major aggressive factors in the pathogenesis of gastric ulcer formation. In the present study, we determined whether or not bFGF has an anti-ulcer action via the central nervous system, using male Wistar rats. The intracisternal injection of bFGF dose-dependently (0.1-1.0 microgram(s)/rat) inhibited the severity of gastric ulcers induced by water-immersion restraint stress or central thyrotropin-releasing hormone. The same doses of peripherally injected bFGF failed to protect the gastric mucosa from these ulcerogenic procedures. These results suggest for the first time that bFGF has a mucosal protective effect through a mechanism involving the central nervous system. It is speculated that this anti-ulcer action of bFGF is, at least in part, dependent upon its gastric antisecretory effect.

Prevention by interleukin-1 of intracisternally injected thyrotropin-releasing hormone (TRH)-induced gastric mucosal lesions in rats

We have recently found that interleukin-1 (IL-1) acts in the central nervous system to potently inhibit gastric acid and pepsin secretion in rats. In the present study, we examined the effects of IL-1 on the development of gastric mucosal lesions induced by intracisternal (i.c.) thyrotropin-releasing hormone (TRH), a neuropeptide known to centrally stimulate gastric secretion. Pretreatment with i.c. injected IL-1 (10 ng/rat) significantly suppressed the severity of TRH-induced gastric erosions. On the other hand, the same dose of i.c. injected IL-1 failed to exert a cytoprotective action for the gastric mucosa against orally administered absolute ethanol. These results suggest that IL-1 has an anti-ulcer effect mainly through its inhibitory action on gastric secretion.

Central nervous system action of basic fibroblast growth factor: inhibition of gastric acid and pepsin secretion

To examine the effects of basic fibroblast growth factor (bFGF) on gastric secretion, the present study was carried out using pylorus-ligated rats. Intracisternally injected bFGF inhibited the secretion of both gastric acid and pepsin, and this gastric antisecretory action of bFGF was a dose-related response. On the other hand, the intraperitoneal injection of bFGF did not change gastric secretion. These results strongly suggested for the first time that bFGF, a growth factor that promotes the proliferation of various cell types, might also be a chemical messenger that is involved in the central regulation of gastric secretion. This biological action of bFGF may be considered as a novel nonmitogenic activity of this growth factor.

Indomethacin reverses interleukin-1-induced hyperinsulinemia in conscious and freely moving rats

With the aim of studying the mechanism by which peripherally injected interleukin-1 increases the serum levels of insulin in conscious rats, the effects of indomethacin, a cyclooxygenase inhibitor, on interleukin-1-induced hyperinsulinemia were examined using male Wistar rats implanted with intra-atrial cannulas. The i.v. injection of interleukin-1 (1 microgram/rat) into conscious rats resulted in a significant increase in serum insulin levels with the peak response being observed 10 min after injection. It was also found that this insulin response to interleukin-1 was dose-related. Pretreatment with indomethacin (3 mg/kg body weight), however, completely blocked the interleukin-1-induced stimulation of insulin secretion. These findings suggest that i.v. injected interleukin-1 stimulates insulin release from the endocrine pancreas by a mechanism involving the prostaglandin system.

Interleukin-1: a cytokine that has potent antisecretory and anti-ulcer actions via the central nervous system

The present study was performed to determine if interleukin-1 (IL-1) acts as a chemical messenger in the central nervous system (CNS) regulation of gastric secretion and ulcer formation, using male Wistar rats. The central injection of IL-1 dose-dependently inhibited gastric acid secretion in pylorus-ligated rats at 100 times smaller doses than the peripheral injection of the cytokine. The action of IL-1 was long-lasting because its antisecretory effect was still evident at 8 hr after injection. Furthermore, it was observed that pretreatment with central IL-1 dose-dependently suppressed the development of gastric ulcers induced by water-immersion restraint stress, a well-established ulcerogenic procedure. These results clearly suggested for the first time that IL-1, a cytokine produced by activated monocytes/macrophages, acts centrally in the brain to exert gastric antisecretory and anti-ulcer actions.

Lipopolysaccharide-induced inhibition of gastric acid and pepsin secretion in rats

We used male Wistar rats to determine the effects of lipopolysaccharide (LPS) on gastric secretion. After pylorus ligation, 24-h fasted rats received i.p. injections of different doses of LPS dissolved in sterile saline. The amounts of gastric acid and pepsin secreted were determined 2, 4 or 8 h after injection. Small doses of LPS (10-1000 ng/rat) significantly inhibited the release of both gastric secretants as compared with control animals, and this inhibitory effect of LPS on gastric secretion was dose-related. The gastric antisecretory effect of LPS was still evident 8 h after injection, indicating that this action of LPS was long-lasting. These results suggest that LPS might be involved in the regulation of gastric secretion under certain pathophysiological conditions such as acute bacterial infections.

Inhibition of gastric pepsin secretion by peripherally or centrally injected interleukin-1 in rats

The present study was carried out to investigate the effects of Interleukin-1 (IL-1) on gastric pepsin secretion in conscious pylorus-ligated rats. The intraperitoneal (ip) injection of IL-1 resulted in a dose-related inhibition of gastric pepsin output. The intracerebroventricular (icv) injection of IL-1 similarly reduced pepsin secretion at 100 times smaller doses than ip IL-1, suggesting that this inhibitory action of IL-1 is mediated by the central nervous system (CNS). In addition, it was found that the antisecretory action of IL-1, both peripherally and centrally administered, lasted throughout the periods observed (2 hr through 8 hr after injection). These results strongly indicate that IL-1 is involved in the CNS regulation of gastric secretion, especially under certain pathophysiological conditions which activate the immune system to release various cytokines including IL-1.

Indomethacin blocks the anorexic action of interleukin-1

It has been reported recently that the central nervous system actions of interleukin-1 are mediated by the prostaglandin system in the brain. The present study was therefore performed in order to examine the hypothesis that indomethacin, an inhibitor of prostaglandin biosynthesis, might alleviate the interleukin-1-induced suppression of food intake in rats. The i.p. injection of interleukin-1 (2 micrograms/rat) resulted in a significant decrease in food intake. The pre-injection of indomethacin (0.5 mg/rat), however, completely blocked the anorexic action of the monokine, while indomethacin on its own did not affect food intake. These results suggested that indomethacin might be clinically useful for improvement of the anorexic state of patients with acute infectious diseases.

Increased ACTH response to corticotropin-releasing factor in cold-adapted rats in vivo

We have recently reported that chronically repeated restraint stress results in improved cold tolerance in rats via an increased activity of nonshivering thermogenesis, a characteristic metabolic change observed during cold adaptation, suggesting the presence of cross-adaptation between cold and stress. It is well established that the hypothalamic-pituitary-adrenal (HPA) axis is activated in various stress responses. In the present study, therefore, we examined whether cold adaptation would alter the adrenocorticotropic hormone (ACTH)-releasing state in vivo using freely moving, conscious rats chronically implanted with intra-atrial cannulas. There was no difference in the basal levels of plasma ACTH between warm control and cold-adapted rats. On the other hand, the ACTH response to the intravenous administration of corticotropin-releasing factor (CRF; 2 micrograms/animal) was significantly elevated in cold-adapted rats. However, the injection of 10 micrograms of CRF, which was considered as a dose to elicit the maximal ACTH response, resulted in similar ACTH release patterns between the two groups. These changes in the responsiveness of ACTH secretion have been observed in rats chronically exposed to stressful conditions. The results demonstrated in the present study, therefore, provide further evidence for our hypothesis that there may exist cross-adaptation between cold and nonthermal stress.

Anorexia induced by interleukin 1: involvement of corticotropin-releasing factor

It has recently been demonstrated by three independent research groups including ours that interleukin 1 (IL-1), a polypeptide hormone produced by activated monocytes or macrophages, or both, stimulates the release of hypothalamic corticotropin-releasing factor (CRF). Since CRF acts centrally in the brain to reduce food intake, we hypothesized that IL-1 might induce anorexia through this central action of CRF. The present study was carried out to examine the hypothesis, using male Wistar rats. Based on three lines of evidence, we report here that IL-1, both endogenously released and exogenously administered, induces the suppression of food intake in rats and that endogenous CRF in the brain is involved in the IL-1-induced anorexia. First, lipopolysaccharide (LPS), a potent stimulant of the release and production of endogenous IL-1, caused anorexia in a dose-related manner, and this effect was significantly blocked by pretreatment with glucocorticoid hormones, which have been shown to inhibit the production of endogenous IL-1 by LPS. Second, intraperitoneal injection of IL-1 resulted in a dose-related suppression of food intake. Third, anorexia induced by IL-1 was diminished by the immunoneutralization of endogenous CRF in the brain. These results provide further evidence of the existence of bidirectional communication between the immune and neuroendocrine systems. Furthermore, this connection between IL-1 and CRF may represent a mechanism by which anorexia results from the activation of the immune system by such immunological challenges as acute infectious diseases.

Interleukin-1 inhibits the secretion of gastric acid in rats: possible involvement of prostaglandin

To examine the hypothesis that interleukin-1 may inhibit the secretion of gastric acid, the present study was carried out using pylorusligated rats. Based upon three lines of evidence, we report here that interleukin-1, both endogenously released and exogenously administered, suppresses gastric acid secretion and that the interleukin-1-induced inhibition of acid output is possibly mediated by prostaglandin. First, lipopolysaccharide, a potent stimulant of the release and production of endogenous interleukin-1, caused the suppression of gastric acid, and this response was dose-related. Second, the intraperitoneal injection of interleukin-1 resulted in a dose-related inhibition of gastric acid output. Third, the administration of indomethacin completely blocked the suppression of gastric acid secretion induced by interleukin-1. These results demonstrated for the first time that IL-1 might be involved in the regulation of gastric secretion.

[The alterations of serum colloid osmotic pressure, serum protein and water balance during prolonged anesthesia]

The changes of serum colloid osmotic pressure (COPm), serum protein and water balance were examined in 9 patients during and for 2 weeks after operation which required prolonged anesthesia. The values of serum total protein (TP), serum albumin (Alb) and COPm decreased by about 17% three hours after the start of anesthesia and by 15%, 20% and 24%, respectively, after 18 hours. These values returned to each preoperative value about one week after the operation. The correlation coefficients (the values in parentheses were calculated using data obtained during anesthesia) comparing COPm to TP, Alb and calculated colloid osmotic pressure (Landis' equation) were 0.661 (0.710), 0.480 (0.649) and 0.666 (0.727). There was no correlation between COPm and water balance. When COPm was 17.5mmHg or lower, calculated colloid osmotic pressure value was higher than COPm as the Alb/TP ratio decreased. Decreases in the values of COPm and serum protein during operation were considered to have been caused mainly by increased capillary permeability.

Inhibition of interleukin-1 beta release from cultured human peripheral blood mononuclear cells by prednisolone

Prednisolone, a water-soluble glucocorticoid hormone, suppressed the secretion of interleukin-1 beta from human peripheral blood mononuclear cells in culture. The prednisolone-induced suppression of the monokine release was dose-related and the half maximal response was observed at 0.1 nM.

[National medical care for urological diseases in Japan]

Several problems involved in the medical care system in Japan were discussed with emphasis on urological diseases. Costs for the treatment of renal insufficiency are increasing. Financial support by the national government is available for some of the patients under 18 years of age, i.e., those with undescended testis, vesicoureteral reflux and hypospadias.

46XX male; report of case

Chromosomal studies on a prepubertal 7-year-old boy with a normal male phenotype except for undescended testes showed a 46XX normal female karyotype. An H-Y antigen assay done at the same time on peripheral blood was positive in a titer similar to that of normal male subjects. Although the microscopic findings for both testes were normal, hypergonadotropic hypogonadism was suggested from both LH-RH and hCG stimulation tests.

[Macroamylasemia, report of two cases]

Serum amylase isozyme was determined in 2 cases with normal urinary amylase but persistantly high serum amylase. Both cases showed dominant S-type amylase associated with tailing findings that was characteristic of macroamylasemia. Moreover, using the immunofixation method, the serum amylase was found to be bound with IgG (K) in case 1 and with IgA (L) in case 2.

Combination chemotherapy including adriamycin for advanced transitional cell carcinoma of the urinary tract

Thirty-three patients with advanced transitional cell carcinoma of the urinary tract (23 bladder cases, 8 ureter cases, and 2 renal pelvis cases) were treated by three-drug combination chemotherapy using two protocols (protocol I: Adriamycin 50 mg/m2, cyclophosphamide 500 mg/m2, and 5-fluorouracil 500 mg/m2, protocol II: Adriamycin 50 mg/m2, cyclophosphamide 500 mg/m2, and cis-platinum 50 mg/m2). Protocol I induced responses in three of 19 patients (16%), (1 complete response, 2 partial responses), and protocol II (I complete response, 4 partial responses) in five of 14 patients (36%). The overall response rate was 24%. The duration of response was relatively short (median duration 5.1 months). The combination therapy was relatively well tolerated except in three patients, including two mortalities. In our study, three-drug combination chemotherapy with Adriamycin, especially that including cis-platinum, was effective against transitional cell carcinoma of the urinary tract, but the results were not completely satisfactory.

Free supernumerary kidney: a case report and review

We report a case of a free supernumerary kidney, which was asymptomatic. Excretory urography and angiography showed 3 separate kidneys.

Total retropubic prostatectomy for carcinoma of the prostate

Total prostatectomy is an effective mode of therapy for early carcinoma of the prostate. This report deals with 74 patients who underwent total retropubic prostatectomy at our hospitals during a 23-year period. The 5-year survival rates of patients with stages A and B, C, and D carcinomas were 84.1, 40.1, and 12.7% respectively. The total 5-year survival rate was 56.1%. The 10-year survival rates compare favorably with those of any other mode of therapy. The histological grade was highly significant with respect to prognosis. Combined orchiectomy with total prostatectomy was effective. Operative mortality was 4.05% (3 patients), and the main complication was incontinence. We strongly believe that total prostatectomy is the only curative treatment for early carcinoma of the prostate. This procedure should be utilized more frequently.