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Rituximab (RIT) is effective as a part of the desensitization therapy before ABO-incompatible kidney transplantation (ABOi-KTx), and a single dose of RIT at 375 mg/mForty-four consecutive ABOi-KTx recipients were enrolled in this retrospective study. Before transplantation, subjects were treated with RIT at various doses, ranging from 65 to 400 mg/body (46-263 mg/mThe incidence of AAMR was significantly higher in the high %CD19 group than in the low %CD19 group (44.4% vs 5.7%, P = .006). Furthermore, multivariate analysis showed that %CD191.2% was the only independent factor to predict AAMR, with an odds ratio of 14.31 (P = .038).High %CD19 values after rituximab administration in ABOi-KTx recipients implies insufficient depletion of B cells, which can lead to AAMR.

Previous studies have suggested that ID influences the depth of general anaesthesia (GA) and delays emergence from GA. In this retrospective cohort study, we investigated whether ID affects the time taken to emerge from GA.We selected dental patients who underwent GA at the Department of Dental Anaesthesiology, Okayama University Hospital, using predefined inclusion and exclusion criteria, before dividing the selected participants into ID and non-ID (control) groups. Relevant data were collected from electronic anaesthesia records. Emergence time, the time from the discontinuation of propofol and remifentanil to tracheal extubation, was recorded for each patient. We compared the data of the ID group and control group. The association between ID and the emergence time was tested for statistical significance. Multivariate linear regression analysis was used to control for confounders.A total of 97 cases (control = 50, ID = 47) were included in the study. The emergence time was significantly longer in the ID group (ID group: 15.8 ± 6.6 min, control group: 10.8 ± 3.6 min). The ID group included more men and lower propofol and remifentanil infusion rates. The treatment time was longer, and the mean bispectral index was lower in the ID group. Sevoflurane inhalation was used only for anaesthesia induction in the ID group. In the multivariate linear regression analysis, ID was found to be significantly associated with a longer emergence time.Our results suggest that ID is associated with a longer emergence time from GA.

The effect of aging on blood pressure (BP) and heart rate (HR) was investigated in a cross-sectional study in the high-altitude community of Leh, Ladakh (altitude: 3524 m) and a Japanese community in U town, Hokkaido (altitude: 25 m). BP and HR were obtained in a sitting position from 332 subjects 13-81 years of age in Ladakh, and from 216 Japanese citizens, 24-79 years of age. Measurements were taken after a 2-min rest, using a semi-automated BP device (UA-767 PC, A and D Co. LTD, Tokyo). High-altitude people showed higher diastolic BP and HR values than lowland people (83.2 vs. 76.9 mmHg and 78.6 vs. 69.2 bpm, P < 0.001), but no difference in systolic BP. Highland people also showed a steeper BP increase with age than the lowland people (systolic BP: 0.7476 vs. 0.3179 mmHg/year, P < 0.0005; diastolic BP: 0.3196 vs. 0.0750 mmHg/year, P < 0.001). This chronoecologic investigation in Ladakh examined the circulation as a physiological system at high-altitude. Our data indicate the need for a more comprehensive cardiovascular assessment for a better diagnosis and a more fruitful treatment. Longitudinal observations of effects of socio-ecologic factors on the cardiovascular system should help prevent strokes and other cardiovascular events, especially at high altitude.

Studies on mercury levels in the Amazonian Region have typically lacked background or reference parameters. A sectional study on Hg concentration in hair and fish was conducted, together with an assessment of the prevalence of signs and symptoms related to Hg poisoning, in four communities in the Amazon Basin not impacted by gold mining, located either by a river course (Santana do Ituqui and Caxiuanã) or by a lake (Aldeia do Lago Grande and Vila do Tabatinga). Mercury determinations in hair and fish were made by flameless atomic absorption spectrophotometry. Mean total Hg in hair was 4.33 microg/g (0.40-11.60 microg/g) in 321 individuals from Santana do Ituqui, 3.98 microg/g (0.40-11.76 microg/g) for 316 persons in Aldeia do Lago Grande, 5.46 microg/g (0.37-49.85 microg/g) for 504 individuals from Vila do Tabatinga and 8.58 microg/g (0.61-45.59 microg/g) for 203 inhabitants from Caxiuanã. Fish consumption was very high in all those communities but no signs or symptoms associated with Hg poisoning were found. Mean Hg concentration in fish varied from 0.006 to 2.529 microg/g for carnivores and from 0.008 to 0.871 microg/g for noncarnivores. These values suggest that further studies including a larger number of communities would eventually lead to values of "normal" Hg concentration in the Amazonian Region quite above the limits suggested by the World Health Organization.

Minist?rio da Sa?de. Funda??o Servi?os de Sa?de P?blica. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Funda??o Servi?os de Sa?de P?blica. Instituto Evandro Chagas. Bel?m, PA, Brasil. Minist?rio da Sa?de. Funda??o Servi?os de Sa?de P?blica. Instituto Evandro Chagas. Bel?m, PA, Brasil. Rio de Janeiro Federal University. Center for Studies in Public Health. Rio de Janeiro, RJ, Brazil. Minist?rio da Sa?de. Funda??o Servi?os de Sa?de P?blica. Instituto Evandro Chagas. Bel?m, PA, Brasil. Executive Secretariat of Industry, Commerce and Mining. Bel?m, PA, Brazil. Minist?rio da Sa?de. Funda??o Servi?os de Sa?de P?blica. Instituto Evandro Chagas. Bel?m, PA, Brasil. AMBIOS - Engeneering and Processes. S?o Paulo, SP, Brazil. Municipal Secretariat of Health. Rio Branco, AC, Brazil. Rio de Janeiro Federal University. Center for Studies in Public Health. Rio de Janeiro, RJ, Brazil. Em?lio Goeldi Paraense Museum. Bel?m, PA, Brazil.

The purpose of this study was to examine the validity of the quantitative measurement of muscle oxidative metabolism in exercise by near-infrared continuous-wave spectroscopy (NIRcws). Twelve male subjects performed two bouts of dynamic handgrip exercise, once for the NIRcws measurement and once for the 31P-magnetic resonance spectroscopy (MRS) measurement as a standard measure. The resting muscle metabolic rate (RMRmus) was independently measured by 31P-MRS during 15 min of arterial occlusion at rest. During the first exercise bout, the quantitative value of muscle oxidative metabolic rate at 30 s postexercise was evaluated from the ratio of the rate of oxyhemoglobin/myoglobin decline measured by NIRcws during arterial occlusion 30 s after exercise and the rate at rest. Therefore, the absolute values of muscle oxidative metabolic rate at 30 s after exercise [V˙o 2NIR(30)] was calculated from this ratio multiplied by RMRmus. During the second exercise bout, creatine phosphate (PCr) resynthesis rate was measured by 31P-MRS at 30 s postexercise [Q(30)] under the same conditions but without arterial occlusion postexercise. To determine the validity of NIRcws, V˙o 2NIR(30) was compared with Q(30). There was a significant correlation betweenV˙o 2NIR(30), which ranged between 0.018 and 0.187 mM ATP/s, and Q(30), which ranged between 0.041 and 0.209 mM ATP/s ( r = 0.965, P < 0.001). This result supports the application of NIRcws to quantitatively evaluate muscle oxidative metabolic rate in exercise.

Background. The postoperative opioid-sparing effects of systemic L-type calcium channel blockers are controversial. We investigated whether the postoperative analgesic effect of epidural fentanyl was enhanced by i.v. infusion of diltiazem at a rate that would minimize any cardiovascular depressant effect. Methods. After elective lower abdominal gynaecological surgery, 30 patients were randomized to receive continuous i.v. diltiazem 1 µg kg–1 min–1 (diltiazem group) or the same volume of saline (control group) for 24 h. Cumulative postoperative epidural fentanyl consumption, visual analogue scale (VAS) scores and verbal rating scores (VRS) at rest and during mobilization, sedation scores, incidence of side-effects and overall patient satisfaction were assessed. Results. There was no significant difference in cumulative epidural fentanyl consumption between the groups at any period. Although there were no statistically significant differences in VAS scores, VRS, sedation scores, incidence of side-effects and overall patient satisfaction, there was a trend to an increased incidence of nausea in the diltiazem group. Conclusion. Continuous i.v. infusion of diltiazem did not reduce epidural fentanyl consumption when administered at dosages having minimal haemodynamic depressant effects. Br J Anaesth 2003; 90: 507–9

This is a review of the main factors currently perceived as threats to the biodiversity of Amazonia. Deforestation and the expansion of the agricultural frontier go hand in hand within the context of occupation and land use in the region, followed by a hasty process of industrialization since the 1950s and, more recently, by a nation-wide attempt to adapt Brazil to economic globalization. Intensive agriculture and cattle-raising, lack of territorial planning, the monoculture of certain crops often promoted by official agencies, and the introduction of exotic species by cultivation are some of the factors affecting Amazonian biodiversity. There are still large gaps in knowledge that need to be dealt with for a better understanding of the local ecosystems so as to allow their preservation, but such investigation is subjected to manifold hindrances by misinformation, disinformation and sheer ignorance from the legal authorities and influential media. Data available for select groups of organisms indicate that the magnitude of the loss and waste of natural resources associated with deforestation is staggering, with estimated numbers of lost birds and primates being over ten times that of such animals illegally commercialized around the world in one year. The challenges to be met for an eventual reversal of this situation demand more systematic and concerted studies, the consolidation of new and existing research groups, and a call for a halt to activities depleting the Amazonian rainforest.

SUMMARYTo investigate two clusters of diarrhoea cases observed in our geriatric hospital wards, the faecal specimens were analysed. Reversed passive latex agglutination assay revealed that 63·2% and 41·7% of the faecal specimens from each cluster were positive forClostridium perfringensenterotoxin. PCR assay revealed that 71·4% and 68·8% ofC. perfringensisolates from each cluster were positive for the enterotoxin gene (cpe). These observations suggested that both the clusters were outbreaks caused by enterotoxigenicC. perfringens. Subsequent pulsed-field gel electrophoresis analysis revealed that the two outbreaks were caused by differentC. perfringensisolates. However, these outbreak isolates as well as other sporadic diarrhoea isolates shared a 75-kb plasmid on which thecpegene and thetcplocus were located. The 75-kb plasmid had horizontally spread to variousC. perfringensisolates and had caused outbreaks and sporadic infections. However, the site and time of the plasmid transfer are unclear.

Effects of high altitude on arterial stiffness and neuro-cardio-pulmonary function were studied. Blood pressure (BP) and heart rate (HR) were measured in a sitting position on resting Ladakhis, living at an altitude of 3250-4647 m (Phey village, 3250 m: 17 men and 55 women; Chumathang village, 4193 m: 29 men and 47 women; Sumdo village, 4540 m: 38 men and 57 women; and Korzok village, 4647 m: 84 men and 70 women). The neuro-cardio-pulmonary function, including the Kohs block design test, the Up and Go, the Functional Reach and the Button tests, was examined in 40 elderly subjects (19 men and 21 women, mean age: 74.7 +/- 3.3 years) in Leh, Ladakh (altitude: 3524 m), for comparison with 324 elderly citizens (97 men and 227 women, mean age: 80.7 +/- 4.7 years) of Tosa, Japan (altitude: 250 m). Cardio-Ankle Vascular Index (CAVI) was measured as the heart-ankle pulse wave velocity (PWV) in these subjects using a VaSera CAVI instrument (Fukuda Denshi, Tokyo). SpO(2) decreased while Hb and diastolic BP increased with increasing altitude. At higher altitude, residents were younger and leaner. Women in Leh vs. Tosa had a poorer cognitive function, estimated by the Kohs block design test (3.7 +/- 3.6 vs. 16.4 +/- 9.6 points, P < 0.0001) and poorer ADL functions (Functional Reach: 13.7 +/- 7.0 cm vs. 25.3 +/- 8.7 cm, P < 0.0001; Button test: 22.5 +/- 4.8 vs. 14.8 +/- 5.7 s, P < 0.0001). Time estimation was shorter at high altitude (60-s estimation with counting: 41.1% shorter in men and 23.0% shorter in women). A higher voltage of the QRS complex was observed in the ECG of Leh residents, but two times measurement of CAVI showed no statistically significant differences between Leh and Tosa (two times of CAVI measures; 9.49 vs. 10.01 m/s and 9.41 vs. 10.05 m/s, respectively), suggesting that most residents succeed to adapt sufficiently to the high-altitude environment. However, correlation of CAVI with age shows several cases who show an extreme increase in CAVI. Thus, for the prevention of stroke and other adverse cardiovascular outcomes, including dementia, CAVI may be very useful, especially at high altitude. In conclusion, elderly people living at high altitude have a higher risk of cardiovascular disease than low-latitude peers. To determine how these indices are associated with maintained cognitive function deserves further study by the longitudinal follow-up of these communities in terms of longevity and aging in relation to their neuro-cardio-pulmonary function.

To identify candidate genes involved in human colorectal carcinogenesis, we constructed the gene expression profiles of 50 colorectal cancers (CRCs) and 12 normal colorectal epithelia using a cDNA microarray specially constructed for CRC. Hierarchical clustering analysis and principal component analysis could clearly distinguish the gene profiles of cancer tissues from those of normal tissues. Our results confirm there are indeed differences in gene expression between cancer and normal mucosa. Our cDNA microarray identified 22 up-regulated genes and 32 down-regulated genes in CRC. Many of these genes have been previously identified in relation to human carcinogenesis, 68% and 78%, respectively. Subsequent validation of selected genes by serial analysis of gene expression and reverse transcription polymerase chain reaction, demonstrated expression patterns that were almost identical to our microarray analysis. Using a four-fold larger sample relative to that used in our previous study, candidate genes involved in human colorectal carcinogenesis were reproducibly identified. Further studies of comprehensive gene expression using our technique may elucidate the mechanism of CRC tumorigenesis.

Post-exercise related time course of muscle oxygenation during recovery provides valuable information on peripheral vascular disease. The purpose of the present study was to examine post-exercise hyperemia (forearm blood flow; FBF, Doppler ultrasound) assessed by peak FBF, excess FBF and the time constant for FBF (FBF(Tc)) following isometric handgrip exercise (IHE). Post-exercise hyperemia was assessed in an ischemic and non-ischemic state at different exercise intensities and durations. Peak FBF and excess FBF were defined as the maximum FBF during recovery, and the total amount of FBF volume, respectively. FBF(Tc) represents the time to reach approximately 37% of the change in FBF between peak FBF and resting FBF (delta peak FBF). Ten subjects performed IHE at "10% and 30% maximum voluntary contraction (MVC)" for 2 min with or without arterial occlusion (AO), followed by 2 min of AO alone (Study I). In Study II, six subjects performed 30%MVC-IHE with AO for "100%, 66%, 33% and 10% of the exhausted exercise duration" (time to exhaustion). In Study I, although peak FBF and excess FBF were significantly higher in ischemic than non-ischemic IHE for both 10% and 30%MVC (p0.05), FBF(Tc) was similar in the ischemic and non-ischemic conditions. The peak FBF, excess FBF and FBF(Tc) were all significantly higher at 30% than at 10%MVC (p0.05). In Study II, the peak FBF and excess FBF increased linearly compared to the absolute and relative exercise durations for ischemic IHE. FBF(Tc) increased exponentially when compared to the absolute and relative exercise durations. These data suggest the ischemic exercise has a larger hyperemic response compared to the non-ischemic exercise. In conclusion, the peak FBF, excess FBF and FBF(Tc) seen during post-exercise hyperemia are closely correlated with exercise intensity and duration, not only in non-ischemic, but also in the ischemic exercise. In combination with the ischemic exercise, these parameters could potentially prove to be valuable indicators of peripheral vascular disease.

During cardiopulmonary bypass, perfusion flow rate is generally calculated only with the patient body surface. Recently, far advanced hemodilution during cardiopulmonary bypass and tepid bypass circulation are common.We have arrived at an appropriate flow rate formula, in which factors like temperature, hemoglobin concentration, the target mixed venous oxygen saturation (SvO2), and the amount of oxygen consumption are included. Our formula was compared with the conventional one.Seventy-four points of cardiopulmonary bypass data under total cardiopulmonary bypass in 33 patients were studied. Our formula's validity was re-evaluated. Then, the SvO2 values were predicted by applying the flow rate value as per conventional calculation in to our formula.The flow rate of our formula and the actual flow rate are well correlated (r = 0.9212). In the prediction of the SvO2 by the conventional method, 36.5% were calculated to have a SvO2 of less than 60%. Furthermore, with a hemoglobin concentration of 7 g/dl, 73.3% were calculated to have a SvO2 of less than 60%. With a body temperature of 34 degrees centigrade, 53.8% were calculated to have a SvO2 of less than 60%. On the other hand, to maintain SvO2 level at 70% by the conventional method, if the patient hemoglobin concentration was 10 g/dl, temperature should be maintained at 36 degrees centigrade, and when hemoglobin concentration is 7 g/dl, the temperature should be maintained at 33 degrees centigrade.In advanced hemodilution or tepid cardiopulmonary bypass, use of appropriate flow rate formula is recommended, which takes into account the indispensable factors such as hemoglobin levels, temperature, and the target SvO2.

Although pineal parenchymal tumours are very rare in elderly patients, we recently successfully treated a 72-year-old male patient. Interestingly, the histology of his pineal parenchymal tumour was mixed pineocytoma/pineoblastoma, which is reported to be extremely rare in aged patients. We present his clinical manifestations, follow-up MRI, surgical treatment, pathological findings, and review the literature.This 72-year-old man had a mass in the pineal region detected 3 years previously on MRI in February 1996 following symptoms of headache and vertigo. Two years later, he experienced gait disturbance and disorientation. CT scans disclosed obstructive hydrocephalus, and ventriculo-peritoneal shunt placement was then performed. The tumour mass began to enlarge in July 1999 (at age 72). On October 13, 1999, total removal of the pineal region tumour was performed through an occipital transtentorial approach. The postoperative course was uneventful. The pathological diagnosis of the tumour was mixed pineocytoma/pineoblastoma.Pineal parenchymal tumours are uncommon in elderly patients, and mixed pineocytoma/pineoblastomas are particularly rare. We followed this patient closely for more than 3.5 years and finally performed total surgical removal of the tumour, with excellent outcome. The present case suggests that a mixed pineocytoma/pineoblastoma tumour is controllable even in elderly patients through careful evaluation and management.

Oral clonidine, an alpha2-adrenergic receptor agonist, reduces the dose of propofol required for laryngeal mask airway (LMA) insertion. Target-controlled infusion (TCI) is becoming increasingly popular for propofol infusion. There is no information, however, on the propofol blood concentrations required for LMA insertion and the effect of oral clonidine premedication on these values.Propofol at target effect-site concentrations from 4.0 to 12.0 microg/ml were randomly administered using TCI in three groups of healthy male patients (n=35 each) who were undergoing elective orthopedic surgery: control, 2.5 microg/kg clonidine, and 5.0 microg/kg clonidine groups. Nothing was administered to the control group. Clonidine(2.5 microg/kg or 5.0 microg/kg) was administered orally 90 min before arrival at the operating room in the clonidine groups. After equilibration between the blood- and effect-site for 15 min, insertion of the LMA was attempted. The EC50 for LMA insertion (measured propofol serum concentration in equilibrium with the effect-site at which 50% of patients do not respond to the insertion of the LMA) was determined by logistical regression.EC50+/-standard error values in the control, 2.5 microg/kg clonidine, and 5.0 microg/kg clonidine groups were 8.72+/-0.55, 7.76+/-0.60, and 5.84+/-0.58 microg/ml, respectively. The EC50 in the 5.0 microg/kg clonidine group was significantly lower than that in the control group (P0.01).The propofol concentration required for LMA insertion in healthy male patients is reduced by premedication with 5.0 microg/kg oral clonidine.

We have analysed retrospectively the relationship between the axial parameters of alignment of the lower limb and the recurrence of varus deformity after high tibial osteotomy. We studied 29 patients (37 knees) with a mean age at surgery of 66 years. The mean follow-up was for 7.4 years (5 to 10.5). Recurrence of varus deformity was defined as an increase in the femorotibial angle of 3 degrees or more, compared with that obtained six months after the operation. There were four patients (four knees) with recurrence of varus deformity. They had a greater varus inclination of the distal femur than those without varus recurrence. An association between varus inclination of the distal femur and horizontal obliquity of the joint surface was observed. Excessive obliquity prevents the shift of weight-bearing to the lateral compartment, and may cause a recurrence of varus deformity after high tibial osteotomy.

We evaluated the effect of low-flow sevoflurane anaesthesia, in which compound A is generated, and isoflurane anaesthesia, in which compound A is not generated (n=13 in each group), on hepatocellular integrity using alpha glutathione S-transferase (GST). Alpha GST is a more sensitive and specific marker of hepatocellular damage than is aminotransferase activity and correlates better with hepatic histology.Sevoflurane or isoflurane were delivered without nitrous oxide with a fresh gas flow of 1 l/min. Concentrations of compound A in the circuit were measured hourly, and plasma alpha GST concentrations were measured perioperatively.Mean duration of anaesthesia was 338+/-92 min in the sevoflurane group and 320+/-63 min in the isoflurane group. Mean compound A concentration in the sevoflurane group was 28.6+/-9.0 ppm. There was no significant difference in alpha GST concentrations between the sevoflurane and isoflurane groups during or after anaesthesia.These results indicate that low-flow sevoflurane and isoflurane anaesthesia have the same effect on hepatic function, as assessed by plasma alpha GST concentrations.

Little is known about the cell kinetics of human solid tumors during radiation therapy.Thirty one patients with cervical squamous cell carcinoma were analyzed by flow cytometry and immunohistochemical staining with Ki-67 antibody for tumor cell kinetics in the early period of radiation therapy.The G0/G1 fraction was significantly larger in stage 3 disease than in stage 2 disease. During radiation therapy, a decrease in the G0/G1 fraction and an increase in the S fraction were observed in stage 3 but not in stage 2 disease. Two reversal patterns of change in the cell cycle appeared in the early period of radiation therapy. The S phase fraction decreased significantly as the G0/G1 fraction of pre-treatment tumors became smaller than 70%, whereas it increased as the G0/G1 fraction became larger than 70%. The S fraction decreased significantly as Ki-67 growth fractions of pre-treatment tumors became greater than 30%, but on the contrary, it increased as the Ki-67 growth fraction became smaller than 30%. Only 2 of 23 patients showed a significant increase of the G2M fraction, reflecting the presence of the G2 block. The Ki-67 growth fraction increased about 26 % at 9 Gy compared with the growth fraction before treatment. Tumors which responded well showed higher G0/G1 fractions and lower S fractions than those which responded badly.The change of cell cycle parameters of the tumors during radiation therapy suggests that two reversal patterns of changes in cell kinetics take place in the early period of radiation therapy, which may have a potential impact in the modification of radiation therapy.

In order to compare the food habits and defecation tendencies by region, a questionnaire survey was conducted of 1722 college women (18-20 years of age) living in Sapporo (146), Sendai (183), Osaka (1214), and Kumamoto (179). (1) When questioned about food habits, less than 58.5% of the respondents in the four groups considered their food intake to be sufficient to maintain their health. In regard to knowledge about their food intake requirements, the positive response was the highest in Sendai (85.8%), followed by Kumamoto (58.2%) and Osaka (50.9%) with the lowest in Sapporo (41.1%) (p0.01, among the four groups). (2) The students in Sendai, Osaka, Kumamoto and Sapporo, 96.2%, 93.5%, 92.9% and 92.5%, respectively, considered that constipation could affect their health (p0.05, among four groups). The percentage of those with regular bowel movements every day, tended to decrease in the order of Osaka (22.2%), Sapporo (21.2%) and Sendai (20.8%), with the lowest in Kumamoto (12.3%). Bowel movements of less than three times a week were reported by 24.7% in Sapporo, 24.0% in Sendai, 23.2% in Osaka and 22.3% in Kumamoto (p0.01, among the four groups). (3) Of those who defecated every day, in terms of time of day, the percentage was high between waking and after breakfast, with the highest percentage in Kumamoto (72.8%) and the lowest in Sapporo (61.2%) (p0.05, among the four groups). For subjects that responded that they should have a bowel movement every day, the highest percentage was in Osaka (91.0%) and the lowest was in Sapporo (83.9%) (p0.05, among the four groups).

This investigation assessed the hemodynamic changes during the slow induction of anesthesia using propofol, and evaluated the effects of cardiac output (CO) and other factors on the hypnotic dose of propofol, the time for hypnosis and the plasma propofol concentration. We studied 26 scheduled surgical patients and induced anesthesia with continuous infusion of propofol at the rate of 15 mg.kg-1.hr-1. The required dose of propofol and time for hypnosis were determined and the plasma concentration of propofol was measured after the administration of propofol 2 mg.kg-1. Cardiac output was determined by dye densitometry using indocyanine green 4 times during induction and CO did not show any significant changes during induction of anesthesia. Multiple linear regression analysis demonstrated that in addition to the age and total body weight, CO determined at achieving hypnosis was significantly related to the plasma concentration of propofol. Cardiac output might affect the pharmacokinetics of propofol during induction of anesthesia.

This study investigated the effect of co-administration of nitrous oxide on the cardiovascular changes during induction of anesthesia with propofol infusion at a low rate. Sixty patients undergoing general anesthesia were randomly allocated into two groups, and received the inhalation of 100% oxygen (group 1) or 60% nitrous oxide and oxygen (group 2) via face mask for 3 minutes before administration of propofol at 15 mg.kg-1.hr-1. After beginning of propofol infusion, patients inhaled each gas continuously and the loss of response to simple commands by the anesthesiologist was considered as hypnosis. The dose and time for achieving hypnosis were determined, and non-invasive blood pressure, heart rate and arterial oxygen saturation were recorded during induction of anesthesia. Cardiovascular changes during induction were not different between the two groups except mean and diastolic blood pressure immediately after oro-tracheal intubation [126 +/- 21 vs. 113 +/- 21 mmHg and 108 +/- 21 vs. 95 +/- 19 mmHg, respectively (mean +/- SD)]. The dose of propofol and the time for achieving hypnosis showed no significant difference (73 +/- 20 vs. 68 +/- 19 mg and 4.8 +/- 1.0 vs. 4.4 +/- 1.0 min, respectively). Almost all patients were sedated with inhalation of nitrous oxide before infusion of propofol, but no additive effect was observed with nitrous oxide and propofol. Co-administration of nitrous oxide during propofol infusion at a low rate was an effective method to avoid undesirable pressor responses against oro-tracheal intubation without causing adverse cardiovascular depression.

The effect of decreased serum concentration of propofol induced by rapid infusion therapy on the EEG was assessed by spectral edge frequency 90% (SEF90) or median frequency (MF) during propofol anesthesia. The eight scheduled surgical patients were administered propofol with a constant rate, and the rapid infusion therapy with 10 ml.kg-1 of acetate Ringer's solution significantly decreased the serum concentration of propofol from 1.96 +/- 0.22 micrograms.ml-1 to 1.68 +/- 0.19 micrograms.ml-1 (approximately 17% reduction). Simultaneous monitoring of SEF90 and MF, however, demonstrated no change during investigation. These results suggest that the mild decrease of the concentration of propofol might not induce the significant change of EEG, or that the reduction of propofol concentration by infusion might be deceptive and produce no significant change in the concentrations of each pharmacological compartment.

Viral fusogenic membrane glycoproteins (FMGs) are candidates for gene therapy of solid tumors because they cause cell fusion, leading to formation of lethal multinucleated syncytia. However, the cellular mechanisms mediating cell death after FMG-induced cell fusion remain unclear. The present study was designed to examine the mechanisms by which FMG expression in hepatocellular carcinoma cells lead to cell death. Transfection of Hep3B cells with the Gibbon Ape leukemia virus hyperfusogenic envelope protein (GALV-FMG) resulted in the formation of multinucleated syncytia that reached a maximum 5 days after transfection (100 nuclei/syncytia). The syncytia were viable for a period of 2 days and then rapidly lost viability by day 5. Mitochondrial dysfunction occurred in GALV-FMG-induced syncytia prior to loss of viability with loss of the mitochondrial membrane potential, cellular ATP depletion, and release of mitochondrial cytochrome c-GFP into the cytosol. The pan-caspase inhibitor, Z-VAD-fmk, did not prevent cell death. However, glycolytic generation of ATP with fructose effectively increased cellular ATP and preserved syncytial viability. These data suggest that expression of FMG in hepatoma cells results in the formation of multinucleated syncytia, causing mitochondrial failure with ATP depletion, a bioenergetic form of cell death with necrosis. This form of cell death should be effective in vivo and enhance the bystander effect, suggesting that FMG-based gene therapy deserves further study for the treatment of hepatocellular and other cancers.

In Japan neurocysticercosis is a rare disease. We report a case of neurocysticercosis with a review of the literature. A 29-year-old man presented focal seizure on the left side. Physical and neurological findings on admission were unremarkable. CT and MRI showed a mass with ring-like enhancement and perifocal edema in the right frontal lobe, as well as multiple small masses with calcification. The main mass measuring 8 mm in diameter, was suspected as the eliptogenic focus, and was totally removed via the transcortical approach. Postsurgically seizures did not recur, and histological examination of the mass confirmed a cysticercus. A therapeutic course of albendazole and praziquantel administered postsurgically was effective for the multiple intraparenchymal masses.

For evaluation of the adequacy of tissue perfusion during cardiopulmonary bypass (CPB), whole-body oxygen consumption rates at different body weights and temperatures are basic and important data. But few studies have analyzed the oxygen consumption estimated from real-time data during CPB in clinical situations. We analyzed retrospectively the oxygen consumption at different body weights (BW) during normothermia (VO2 37) and the oxygen consumption ratio at different body temperatures (BT; %VO2X; X = BT) from the CPB charts of 189 cases. From these charts, 877 data points for oxygen consumption during total CPB were calculated by Fick's law. By statistical analysis of these data, we derived the following formulae: VO2 37 (ml/kg/min) = 7.6481 x BW0.0679, R2 = 1.0 (BW8 kg) VO2 37 (ml/kg/min) = 32.394 x BW-0.625, R2 = 0.92 (BWor = 8 kg) %VO2X (%) = 4 x 10(-5) x BT4.0777, R2 = 0.42. These formulae indicate that (1) the whole-body oxygen consumption during total CPB can be measured by subtracting the oxygen consumption associated with circulatory and respiratory processes from the oxygen consumption derived from the basal metabolism; and (2) although the change in oxygen consumption induced by hypothermia is variable depending on body weight, the rate of change shows no difference regardless of the patient's weight.

We present a surgical case of a dissecting aneurysm of the right middle cerebral artery associated with subarachnoid hemorrhage and intracranial hemorrhage. A 61-year-old woman with consciousness disturbance and left hemiplegia was referred to our hospital. She had suffered severe headache for a week. CT scan showed a subarachnoid hemorrhage in the right Sylvian fissure and intracranial hemorrhage in the right putamen. The right carotid angiogram revealed string sign in M1 portion and occlusion at M2 lower branch of the right middle cerebral artery. On the 12th day, we undertook surgery to confirm whether it was a dissecting aneurysm or not. In the operation, it was reddish in the M1 portion corresponding to the "string sign" and dark-purplish in the lower M2 portion corresponding to an "aneurysm-like lesion". To prevent bleeding, the arterial wall in the M1 portion was coated using muscle. Though the left hemiplegia was unchanged, the postoperative course was uneventful. The patient was transferred to another hospital and underwent rehabilitation. There has been no reccurrence during the four years since surgery. The middle cerebral artery dissecting aneurysm is extremely rare. We presented this case with review of the literature.

We have investigated the cardiovascular and plasma noradrenaline response to surgical incision under sevoflurane anaesthesia and determined the end-tidal concentration of sevoflurane that blocks the adrenergic response or responses to surgical incision (MACBAR) and changes in mean arterial pressure (MAP) in response to surgical incision (MACBCR) in 50% of women. We randomly assigned 64 female patients, aged 20-49 years, to eight groups according to end-tidal sevoflurane concentration: 5.0%, 5.5%, 6.0%, 6.5%, 7.0%, 7.5%, 8.0% and 8.5%. All patients received only sevoflurane anaesthesia. An increase of 10% or more from prestress (incision) values of MAP or plasma noradrenaline concentration was considered a positive response. The probability of no response to stress was analysed using logistic regression to obtain the probability of no response vs. end-tidal sevoflurane concentration and the best-fit curve from the maximum likelihood estimators of the model parametes. MACBAR (mean +/- SE) was 8.0 +/- 0.2%, MACBCR was 7.9 +/- 0.2%. However, such high doses of sevoflurane cannot be used clinically because of their high toxicity. It may be preferable to combine sevoflurane with other anaesthetics to reduce haemodynamic responses to strong stimulation.

The purpose of this study was to quantify muscle deoxygenation in human skeletal muscles using near infrared time-resolved spectroscopy (NIRTRS) and compare NIRTRS indicators and blood saturation. The forearm muscles of five healthy males (aged 27-32 yrs.) were monitored for changes in hemoglobin saturation (SO2) during 12 min of arterial occlusion and recovery. SO2 was determined by measuring the temporal profile of photon diffusion at 780 and 830 nm using NIRTRS, and was defined as SO2-TRS. Venous blood samples were also obtained for measurements of SvO2, and PvO2. Interstitial PO2(PintO2) was monitored by placing an O2 electrode directly into the muscle tissue. Upon the initiation of occlusion, all parameters fell progressively until reaching a plateau in the latter half of occlusion. It was observed at the end of occlusion that SO2-TRS (24.1 +/- 5.6%) agreed with SvO2 (26.2 +/- 6.4) and that PintO2 (14.7 +/- 1.0 Torr) agreed with PvO2 (17.3 +/- 2.2 Torr). The resting O2 store (oxygenated hemoglobin) and O2 consumption rate were 290 microM and 0.82 microM s-1, respectively, values which reasonably agree with the reported results. These results indicate that there was no O2 gradient between vessels and interstisium at the end of occlusion.

We studied 37 patients with varus osteoarthritis of the knee to determine the influence of the bone mineral density (BMD) on the varus deformity. There were 15 men (21 knees) and 22 women (38 knees). The mean age of the men was 69 years and of the women 68 years. BMD was measured in the L1-L4 spinal region using dual X-ray absorptiometry. In the women a low level of BMD was associated with varus deformity originating at the proximal tibia, but a high level was predominantly linked with deformity originating in the joint space. Similar findings were obtained in the men. Our results suggest that a low BMD predisposes to trabecular microfractures and consequently increased stress on the articular cartilage. A low BMD does not preclude osteoarthritic change in the knee.

We report on a schizophrenic patient whose tardive dystonia, delusions, and auditory hallucinations showed remarkable concurrent improvement after replacing haloperidol with risperidone. The present finding suggests that the 5-hydroxytryptamine-2 (5-HT2) antagonistic action of risperidone has brought about the improvement in tardive dystonia. The 5-HT2 antagonistic action of risperidone, in addition to its dopamine antagonistic action, may have also lessened psychotic symptoms in the current case.

It is postulated that an enhanced production of nitric oxide by inflamed intestine plays a role in the pathophysiology of active inflammatory bowel disease. In this study, systemic NOx concentrations and colonic nitric oxide synthase activity were determined in patients with ulcerative colitis or Crohn's disease. The relationship between these two parameters and disease activity, as well as differences in nitric oxide synthase activity between ulcerative colitis and Crohn's disease, were areas of specific focus. Patients with active ulcerative colitis and Crohn's disease had significantly elevated plasma NOx concentrations; a positive correlation was found between NOx values and inducible nitric oxide synthase activities in the active mucosa of these patients. In active ulcerative colitis, levels of inducible nitric oxide synthase were significantly elevated in both normal and inflamed mucosa, although inducible nitric oxide synthase activity was higher in the latter. These colonic inducible nitric oxide synthase activities correlated well with the results of endoscopic and histologic grading of inflammation. There was no increase in constitutive nitric oxide synthase activity in patients with active ulcerative colitis. However, constitutive nitric oxide synthase activity was significantly increased in the inflamed mucosa in patients with Crohn's disease. In Crohn's disease, elevated inducible nitric oxide synthase activity was found in both normal and inflamed mucosa, with no significant difference between the tissues. Such differences in nitric oxide production in the colonic mucosa possibly reflect the significant differences in the pathophysiology and characteristic clinical features between ulcerative colitis and Crohn's disease.

We present here an interesting case of multiple dural arteriovenous shunts (dAVS) in different locations at the same time. There have been very few reports on multiple dAVS. A 63-year-old man was admitted with a sudden onset of headache and vomiting. CT scan showed a typical subarachnoid hemorrhage (Fisher Group 3). Cerebral angiogram (6 vessel study) revealed two dural arteriovenous shunts at the same time. One was located on the anterior fossa fed by the anterior ethmoidal artery, and the other was located on the posterior fossa near the marginal sinus fed by the left ascending pharyngeal and occipital arteries. At first, transarterial embolization was performed for dAVS located on the posterior fossa. Radical operation was performed for both anterior and posterior fossa dAVS. Both dAVS had disappeared on postoperative angiograms.

Contrast sensitivity was measured in patients with mild diabetic retinopathy using a contrast sensitivity analyser on a personal computer to evaluate visual function. The effect of nicardipine hydrochloride for visual function in mild diabetic retinopathy was also evaluated. Suppression of contrast sensitivity in a comprehensive band of spatial frequency was seen in the patients with normal visual acuity. Apparent improvement of contrast sensitivity was seen in the patients after 3 months of nicardipine hydrochloride treatment. It became clear that even if patients with mild diabetic retinopathy have normal visual acuity, measurement of contrast sensitivity is very important to evaluate the visual function. We also found that nicardipine hydrochloride is effective in treating the impairment of visual function in patients with mild diabetic retinopathy.

We reported a very rare case of an epidural hematoma soon after nose blowing. A 22-year-old male visited our hospital complaining of severe headache and nausea soon after he blew his nose. Thirteen years ago, he had a ventriculo-peritoneal (V-P) shunt operation for a pineal region tumor which had not recurred after irradiation. His left auditory tube had been patent. He hit his head about 3 months ago. On his arrival, his consciousness was almost clear but we observed slight right hemiparesis. Computed tomography of his head obtained on the first day showed the air in the hematoma in the left parietal epidural space which penetrated his petrosal bone from the mastoid air cells. Removal of his epidural hematoma was performed the next day and there was no abnormality of his parietal bone, dura and meningeal arteries. We supposed that nose blowing was what triggered his epidural hematoma. From pressure of nose blowing, the air of his nasopharyngeal space passed through his patent auditory tube into the tympanic cavity, and entered into the epidural space penetrating a microfracture or dissociation in the petrosal bone. In addition to this, V-P shunt system and the looser adhesion of dura to the skull in the young promoted entrance of air. Associated with formation of epidural hematoma in this case were four factors, "patency of auditory tube", "defect or microfracture of petrosal bone", "V-P shunt", "younger age" and triggered by nose blowing.

Coronary artery fistula and coronary artery-cardiac chamber shunts were observed in 16 cases out of 462 consecutive cases in which coronary angiography was performed. 9 of these cases had coronary artery fistula, 5 of the cases had coronary artery-cardiac chamber shunts. 2 cases had both of these conditions. Coronary artery fistula has a draining vein originating from the coronary artery and an entering vein terminating in the cardiac chamber or the pulmonary artery. Coronary artery-cardiac chamber shunts have no such veins, and contrast material used in the injection phase of coronary angiography escapes directly into the cardiac chamber. 2 cases of coronary artery fistula, 2 cases of coronary artery-cardiac chamber shunts, and 1 case involving the both of these conditions showed positive results in submaximal exercise tolerance tests, and no significant arteriosclerotic changes in the coronary artery. These factors lead us to suggest that coronary artery-cardiac chamber shunts cause cardiac ischemia for the same reason that coronary artery fistula does.

The purpose of this study was to measure O2 consumption of nonexercising skeletal muscles (VO2nonex) at rest and after aerobic exercise and to investigate the stimulant factors of O2 consumption. In experiment 1, we measured the resting metabolic rate of the finger flexor muscles in seven healthy males by 31P-magnetic resonance spectroscopy during a 15 min arterial occlusion. In experiment 2, the VO2nonex of the finger flexor muscles was measured using near infrared continuous wave spectroscopy at rest, immediate postexercise, and 3, 5, 10, 15, and 20 min following a cycling exercise at a workload corresponding to 50% of peak pulmonary O2 uptake for 20 min. We also monitored deep tissue temperature in the VO2nonex measurement area and determined catecholamines and lactate concentrations in the blood at rest and immediate postexercise. VO2nonex at rest was 1.1 +/- 0.1 microM O2/S (mean +/- standard error) and VO2nonex after exercise increased 59.6 +/- 7.2% (p < 0.001) from the resting values. There were significant correlations between the increase in VO2nonex and the increase in epinephrine concentration (p < 0.01), and between the increase in VO2nonex and the increase in lactate concentration (p < 0.05). These results suggest that epinephrine and lactate concentrations are important VO2nonex stimulant factors.

Traumatic intracranial aneurysm is rare lesion which is complicated severe head injury. In spite of this rarity, this aneurysm is well known by the fact of high probability of rupture, and high mortality rate. Ninety-four cases of traumatic aneurysms, including 5 cases of our own are discussed. In 94 cases, 83 cases (88.3%) are located at the middle cerebral arteries and/or the anterior cerebral arteries. There are only 2 cases (2.1%) located at the posterior fossa. All of these 94 aneurysms are situated at the peripheral arteries and/or cortical branches, in the distance of Willis' arterial ring. There are 8 cases which lead to be cured spontaneously without any surgical treatment. It was reported by some authors that the traumatic intracranial aneurysms expecting spontaneous healing had some characteristics by the cerebral angiography, such as irregular shapes, and unclear connections from parent arteries. However, these characteristics are sometimes common in the traumatic intracranial aneurysms. Therefore, it is actually difficult to differentiate spontaneous healing aneurysms from deteriorating ones. As for the prognosis of these 79 cases which are able to be examined, the mortality rate of non-surgical group is 4 times higher compared with that of the surgical group, that is the former 40%, and the latter 11%, respectively. According to these facts, authors concluded that the principle therapy of traumatic intracranial aneurysm is surgical treatment.

A comprehensive mapping of epitopes on the carcinoembryonic antigen (CEA) molecule has been achieved by analyses of the specificities of 146 monoclonal antibodies (MAbs) from more than 300 hybridomas established recently. The reactivities of MAbs were analyzed by radioimmunoassays (RIA) with highly purified preparations of CEA and related antigens including normal fecal antigen-1 (NFA-1), NFA-2 in normal adult feces, nonspecific cross-reacting antigen (NCA) in lung and NCA-2 in meconium. The MAbs could be divided into five groups: group I, 23 clones directed to the NCA-common part of the CEA molecule; group II, 31 clones directed to the normal fecal cross-reacting antigen (NFCA)-common part; group III, 46 clones directed to the NFA-1-common part; group IV, 33 clones reactive with the heterogeneous carbohydrate part; and group V, 13 clones directed to the CEA-distinctive part which seemed to be highly specific for CEA. Mutual inhibitions of CEA binding between MAbs of the individual groups revealed that at least 25 different subgroups can be defined i.e., 4, 7, 8, 4, and 2 subgroups in groups I to V, respectively. The epitopes recognized by the group IV MAbs were found to be sensitive to oxidation with periodate, while the epitopes defined by MAbs of the other groups were resistant to this treatment. A solid-phase sandwich-type RIA system for CEA was established by using 2 MAbs from groups II and III as the CEA catcher and an MAb of group V as the tracer. This assay was shown to exhibit improved cancer-specificity and accuracy in the estimation of serum CEA levels.

A 7-year-old boy was admitted because of convulsive seizures. He was diagnosed as agenesis of corpus callosum associated with interhemispheric cyst by CT scan and angiography. Metrizamide CT cisternography and cystography disclosed no communication between interhemispheric cyst and the third ventricle. By means of metrizamide CT cisternography and cystography, the authors considered this interhemispheric cyst gradually increased by some kinds of ball-valve mechanism. Cysto-peritoneal shunt was carried out. Postoperative course was uneventful and follow-up CT revealed disappearance of interhemispheric cyst and typical findings of the acallosal brain. Improvement of clinical symptoms and EEG findings occurred after operation. Agenesis of the corpus callosum associated with interhemispheric cyst is rare. The authors can find only one case of this brain anomaly in the literature in which there is no communication between interhemispheric cyst and the third ventricle. Metrizamide CT cisternography and cystography was very useful in diagnosis and selection of treatment.

Bacterial colonization of mucosal surfaces may be mediated by bacterial adherence to epithelial cells. To study the role of adherence in gram-negative bacillary colonization of the upper respiratory tract, we studied 32 noncolonized patients undergoing elective surgery. Adherence of Pseudomonas aeruginosa and 3 other bacilli to patients' buccal cells in vitro was studied pre- and postoperatively; results were correlated with occurrence of bacillary colonization of the oropharynx in vivo. Adherence of all species was similar. Preoperatively, mean +/- SD adherence was 4.3 +/- 2.0 Pseudomonas aeruginosa/cell. Postoperatively, adherence of Pseudomonas aeruginosa exceeded 8.3 (preoperative mean + 2 SD) bacilli/cell in 16 patients, 11 (69%) of whom became colonized. None of 16 patients whose cells adhered fewer than 8.3 bacilli/cell postoperatively became colonized. Buccal cell binding of 3H-concanavalin A was increased both pre- and postoperatively among patients who became colonized. Gram-negative bacillary colonization of the upper respiratory tract is associated with increased adherence of bacilli to buccal cells. Epithelial cell binding may provide the mechanism whereby ill patients are rendered susceptible to colonization.

Six mouse monoclonal antibodies reactive with carcinoembryonic antigen (CEA) were prepared and used for the analysis of the antigenic heterogeneity of CEA in patient sera. Their reaction specificity and the chemical nature of antigenic epitopes recognized by them were analyzed by radioimmunoassay on the basis of reactivities with different preparations of CEA, normal fecal antigen 2, and nonspecific cross-reacting antigen 2 before and after chemical and/or enzymatic treatment. Two antibodies, F3-30 and F4-82, raised with CEA were reactive with different peptide epitopes on the antigen molecules and revealed a quite universal reactivity with all CEA, normal fecal antigen 2, or nonspecific cross-reacting antigen 2 preparations tested. The serum CEA values obtained with these antibodies were highly correlated with those obtained with conventional radioimmunoassays for CEA. The other four antibodies (F4-11 and F33-37 raised with CEA, F8-52 with normal fecal antigen 2, and F48-60 with nonspecific cross-reacting antigen 2) were found to recognize carbohydrate epitopes with different specificities and revealed very heterogeneous reactivities. The serum CEA values estimated with these four antibodies were highly variable depending on the antibody used, suggesting that the expression of carbohydrate epitopes on the CEA molecules in patient sera was quite heterogeneous. The antigenic heterogeneity of the carbohydrate epitopes was detected even in a single patient serum by affinity chromatography. The causes that give rise to the difference in CEA values between the Roche and the Daiichi kits were analyzed on the basis of reactivities of three groups of patient sera, which showed extremely different ratios for the Roche and Daiichi kits, with monoclonal anti-carbohydrate antibodies. The results obtained suggest that, at least in part, the diversity of antigenic expression on carbohydrate chains on the CEA molecules in patient sera and the variation in specificity or quantity of anti-carbohydrate antibodies in the polyclonal antibody preparations used for the respective assay systems may result in the differences in the estimated CEA values.