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We described a case of ventricular fibrillation in patients with Brugada type electrocardiogram (ECG) during surgery. A 63-year-old man underwent lung lobectomy under combined general and epidural anesthesia. His preoperative ECG showed Brugada type, but he was asymptomatic and did not have a family history of sudden death. Anesthesia was induced using propofol, vecuronium and fentanyl, and maintained using propofol and lidocaine via epidural catheter. One hour into operation, ventricular fibrillation developed. After cardiac compression in a few seconds, sinus rhythm was restored and blood pressure was elevated. When the wound was sutured, ventricular fibrillation occurred again. Defibrillation was attempted immediately and sinus rhythm was restored. We diagnosed coronary spastic angina after acetylcholine challenge test. Previous report describes that the incidence of vasospasm in Brugada type ECG cases is relatively higher than those with the normal ECG. In addition, ventricular fibrillation might be induced by local anesthetics because these agents were administrated 10 minutes before the few events and balance of autonomic nervous system was changed. We conclude that strict monitoring and immediate treatment for ventricular fibrillation are important for anesthetic management in asymptomatic patient with Brugada type ECG.

We experienced a case of submucosal hematoma of the esophagus noticed after cervical anterior spinal fusion (ASF) between C7 and T1 for ossification of posterior longitudinal ligament (OPLL). The patient was a 68-year-old man, and no abnormality was found in the preoperative examinations. Anesthesia was induced and maintained with remifentanil, propofol and vecuronium. Tracheal intubation was performed using fiberscope uneventfully, and gastric tube and esophageal stethoscope were inserted into the esophagus smoothly. The operation was completed in 7 hours and 10 minutes. When we removed the gastric tube and the esophageal stethoscope after the operation, no bloody secretion was noticed. The next day, the patient complained of melena, and gastrointestinal endoscopy showed a submucosal hematoma extending from the posterior wall of the cervico-thoracic border in the esophagus to the cardia. Submucosal hematoma of the esophagus is a rare complication. In this case, surgical procedure was suspected to have caused the hematoma, since the upper end of the hematoma corresponded to the surgical field.

A reduction of the biological half life of toluene in blood in the simultaneous exposure to toluene and alcohol vapors has been reported. To clarify the cause of this reduction, gene expression of CYP mRNA in liver of rats exposed to bi-component organic vapors was investigated. Wistar male rats were repeatedly exposed to 500 ppm of toluene and 300 ppm of 1-butanol vapors individually and simultaneously by inhalation 6 hours a day, five days a week for 4 weeks. After the exposure, the rats were sacrificed and the livers were collected and homogenized. RNA was extracted from the livers, and gene expression of CYP mRNA was observed by reverse transcription-polymerase chain reaction (RT-PCR). The gene expression of CYP3A2 in the simultaneous exposure group was significantly higher than that in the toluene exposure group. However, there was no significant difference in that of CYP1A2, CYP2B1, CYP2C11, CYP2E1 and CYP4A1.

The general pharmacological study of iodixanol, a non-ionic isotonic contrast medium, was conducted. 1) Iodixanol administered intravenously over a dose range of 320 to 3,200 mgI/kg had little or no effect on the general behavior, spontaneous locomotor activity, hexobarbital sleeping time, pain response, electroshock- or pentylenetetrazol-induced convulsion (mouse), EEG or body temperature (rabbit), gastrointestinal propulsion (mouse) or skeletal muscle contraction (rabbit). Iodixanol had no specific interaction with acetylcholine, histamine, serotonin, nicotin, BaCl2 (ileum), methacholine (trachea), isoprenaline (atrium) or oxytocin (pregnant uterus), nor had any effect on spontaneous contractility (atrium and uterus), or transmural electrostimulation-induced contractility (vas deferens) at concentrations of < or = 3.2 x 10(-3) gI/ml in vitro. Iodixanol had no effect on the cardiovascular system of dog, except that it increased femoral blood flow and respiratory rate at doses of > or = 1,000 mgI/kg. Iodixanol at 3,200 mgI/kg i.v. reduced urine output with a decrease in Na+ and Cl- excretion, whereas at 320 mgI/kg i.v., it slightly increased urine output (rat). 2) Injections of iodixanol into the cerebroventricular (0.96, 9.6 mgI/mouse and 3.2, 32 mgI/rat), left ventricular (1,920, 6,400 mgI/dog) or coronary artery (640, 1,920 mgI/dog) had no conspicuous effect on the central nervous system or the cardiovascular system, respectively. There was no marked difference among iodixanol, iohexol and iopamidol in this respect. Vascular pain during injection into the femoral artery (300-320 mgI/guinea pig) appeared to be less intense with iodixanol, compared with the other contrast media iohexol and iopamidol. These results suggest that intravenous injection of iodixanol is relatively free from pharmacological activity, and effects of iodixanol on the central nervous system (intracerebroventricular injection) and cardiovascular system (intra-left ventricular and -coronary injections) are comparable to those of iohexol and iopamidol. Furthermore, intra-femoral injection of iodixanol has less of a tendency to produce vascular pain than those of iohexol and iopamidol.

We investigated the mechanisms of CPT-11-induced diarrhea. 1) CPT-11 (80 mg/kg, i.v.) induced watery diarrhea within 1 hr after dosing in saline-loaded (10 ml/kg, p.o.) rats. This was partially inhibited by subcutaneous injection of atropine (1 mg/kg) or ondansetron (1 mg/kg) and almost completely inhibited by a combination of atropine and ondansetron or by clonidine (0.3 mg/kg) or morphine (10 mg/kg) alone. 2) CPT-11 at the same dose reduced intestinal fluid absorption, which was blocked by the anti-diarrheal agents mentioned above. Intraluminal injection of CPT-11 (20 mg/2 ml) inhibited fluid absorption and induced fluid secretion. 3) CPT-11, 60 mg/kg, by single intravenous injection induced fewer enzymological and histological changes in the small intestine than 5-FU at 270 mg/kg, while 4 consecutive dosings of CPT-11 induced delayed diarrhea (days 5-7) associated with disruption of intestinal integrity. Co-administration with anti-diarrheal agents, except for ondansetron, protected against watery diarrhea appearing within 1 hr after CPT-11 on days 3 and 4, but worsened delayed diarrhea. These results suggest that single injection of higher doses of CPT-11 causes watery diarrhea at an acute phase at least partly by reducing fluid absorption or increasing secretion, and that while conventional anti-diarrheal agents protect against watery diarrhea, their co-administration in repeated CPT-11 administration has no ameliorative effect on CPT-11-induced delayed diarrhea.

Cardiovascular effects of cinepazide were compared with those of cinnarizine and papaverine. Cinepazide (3-30 mg/kg, i.v.) produced a dose-related and transient increase in vertebral, carotid, renal and femoral arterial flow as well as cardiac output and a decrease in total peripheral resistance in anesthetized dogs. The magnitude and duration of mesenteric vasodilatation induced by cinepazide was much greater as compared to other vascular effects, and these effects were associated with a prolonged hypotension. The drug exerted positive inotropic and chronotropic actions, the latter being followed by bradycardia with the highest dose. Cinnarizine (0.3-3 mg/kg, i.v.) produced a greater increase in vertebral blood flow with bradycardia and papaverine (0.1-1 mg/kg, i.v.) produced a remarkable carotid vasodilatation with cardiac stimulation. Both reference drugs decreased renal blood flow. Cinepazide (30 mg/kg, i.v.) potentiated the vertebral vasodilator response of dogs to intravertebral adenosine and cyclic AMP, while cinnarizine (3 mg/kg i.v.) reduced their vasodilator effects. Intravertebral cinepazide(1-10 mg), like cinnarizine (0.1-1 mg) and papaverine (0.1-1 mg), increased vertebral blood flow in a dose-related manner and the effect was partially inhibited by intravenous pretreatment with aminophylline but not by pretreatment with autonomic antagonists. These antagonists did not modify the cinnarizine effect. Cinepazide resembled cinnarizine and papaverine in that the drug antagonized rabbit aortic contraction induced by KCl, norepinephrine or CaCl2.

Effects of cinepazide, a vasoactive agent, on regional circulations in various sites of brain and other organs in curarized, artificially respirated cats were studied using a thermoelectrical method. The mechanism of the vascular effect was also investigated. Cinepazide produced a marked increase in blood flow in the cerebellar cortex and an apparent increase in blood flow in the cerebral cortex. Effects of the drug on blood flow in the thalamus, hypothalamus and amygdala were inconsistent. Cinepazide produced the most significant increase in myocardial blood flow and also an apparent increase in muscular blood flow, whereas the drug did not consistently alter hepatic blood flow, and decreased renal and dermal blood flow. Cinepazide produced a mild and sustained fall in blood pressure, however, a transient slight rise in blood pressure was noted when the drug was given into the vertebral artery. It seems possible that the action of cinepazide might involve a mild stimulation of beta adrenergic receptors and slight stimulation of alpha adrenergic receptors but not cholinergic receptors, in the cerebral and peripheral vascular systems. Increase in blood flow induced by cinepazide seems to be mainly due to the smooth muscle relaxant effect and may be mediated via a metabolic mechanism.

Budralazine was evaluated for its protective effect on the onset of cerebrovascular lesions in SHR given 1.5% NaCl as drinking water. The salt-loading for 67 days rapidly accelerated the development of hypertension in SHR (from 180 to over 250 mmHg, 40 days after the loading). The acceleration of hypertension was accompanied by an increase in the incidence of brain softening, cerebral infarct, angionecrosis and hemorrhage by 30-60% following the thrombosis and necrosis of cerebral arterioles. Renal angionecrosis associated with the interstitial nephrosis was also observed by 90% in the animals. Throughout the salt-loading period, oral administration of budralazine (1, 4 and 15 mg/kg/day) resulted in a dose-dependent inhibition of the accelerated hypertension. At larger doses (4 and 15 mg/kg/day), budralazine almost completely ameliorated the cerebral and renal lesions and significantly attenuated the rise of weight in the brain and heart observed in the salt-loaded control rats. Changes in the serum biochemical findings were also inhibited by this drug. In some of the parameters measured, budralazine appeared to be more efficacious than hydralazine (1, 4 and 15 mg/kg/day, p.o.). These results suggest that budralazine attenuates the serious development of hypertension and reduces the incidence and severity of stroke in salt-loaded SHR.