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We have compared deep body temperature (DBT) measured at the forehead with the core temperatures of the nasopharynx, oesophagus and rectum during the warming phase of cardiopulmonary bypass (CPB) (moderate hypothermia of 26.7-29.6 degrees C) in 12 patients. DBT was measured transcutaneously by an insulated thermistor probe that created an area of zero thermal flow between skin and subcutaneous tissue. The core temperatures measured at different sites lagged behind the increase in arterial blood temperature during warming. The trend was most marked with rectal temperature and least with oesophageal temperature. Among all measurements, the closest linear relationship was found between forehead DBT and nasopharyngeal core temperature (0.99 x nasopharyngeal temperature (degrees C) -0.07; SEE = 0.53; r = 0.99; P < 0.0001). Forehead DBT measurement may be useful as a reliable non-invasive method of monitoring cerebral temperature during CPB.

A 35-year-old man with chronic myeloid leukemia whose peripheral leukocyte count was 18.6 x 10(4).mm-3 underwent splenectomy. Perioperative arterial blood gas analysis showed lower oxygen saturations than those measured with pulse oximetry. The findings suggested pseudohypoxemia because of marked leukocytosis.

Microorganisms grow rapidly in propofol. Extrinsic contamination of propofol is thought to be a source of postoperative sepsis and wound infection. We studied growth of a strain of Escherichia coli in thiopental, propofol, lidocaine, and mixtures of propofol and lidocaine.The pathogen was exposed to 2.5% thiopental; 1.0% propofol; 1.0%, 2.0% and 4.0% preservative-free lidocaine; and propofol solutions containing 0.25%, 0.5%, 1.0%, 2.0%, or 4.0% lidocaine for 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 h at room temperature, respectively. The inocula from these suspensions were cultured for 48 h at 37 degrees C after the antimicrobial activity of the local anesthetics in the inocula was inactivated by a 1:1000 dilution with distilled water.No organisms grew after exposure to 2.5% thiopental. The exposure of E. coli to propofol increased the colony count to approximately 90 times the control count. The colony counts of E. coli after exposure to 1.0%, 2.0% and 4.0% lidocaine and 0.25%, 0.5%, 1.0%, 2.0% and 4.0% lidocaine in 1.0% propofol were lower than the counts after exposure to 1.0% propofol (P = 0.0048, 0.0027, 0.0003, 0.0503, 0.0188, 0.0080, 0.0044, and 0.0001, respectively). The growth rate of the microorganism was significantly higher in cultures exposed to 1.0% propofol than that in cultures exposed to lidocaine alone or lidocaine-propofol mixtures (P0.0001, respectively).Lidocaine possesses bacteriostatic activity against E. coli. Addition of lidocaine to propofol confers its bacteriostatic activity to the mixture and may decrease the hazard of infection associated with the extrinsic contamination of propofol.

SUMMARY The mechanism of anti-tumour activity by BCG is not known clearly. However, many studies suggest that immunological response is related to effectiveness of intravesical instillation of BCG in the therapy for superficial bladder carcinoma. Peripheral blood mononuclear cells (PBMC), urine and serum were obtained from patients with superficial carcinoma at various times during the course of BCG instillation. Urine of patients showed increased levels of IL-1β, IL-2, IL-6, tumour necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and macrophage colony-stimulating factor (M-CSF) after BCG instillation. Levels of IL-2 and IFN-γ in the serum also increased after BCG instillation, but IL-1β, IL-6, TNF-α and M-CSF were not detectable. Maximal levels of IL-2 and IFN-γ in the urine or serum were shown after the fourth instillation. BCG-induced killer cell activity in PBMC increased significantly after the third BCG instillation. These results suggest that BCG instillation involved not only local immunological efforts but also systemic immune responses. Tumour-free patients produced higher BCG-induced killer cell activity than tumour recurrence patients. BCG-induced killer cell activity may be useful for monitoring the effectiveness of intravesical BCG instillation.

BACKGROUND: The rate at which the bactericidal activity of preservative-free bupivacaine develops at body temperature and at room temperature is not known. We studied the bactericidal activity of preservative-free bupivacaine on two strains of methicillin-resistant Staphylococcus aureus (MRSA), two strains of methicillin-susceptible S. aureus (MSSA), and each of Staphylococcus epidermidis and Escherichia coli. METHODS: The pathogen was exposed to 0.5% bupivacaine for 1, 3, 6, 12, and 24 h at 37 degrees C and room temperature. In addition, each strain of MRSA, MSSA, and S. epidermidis was exposed to distilled water, and 0.125%, 0.25%, 0.5%, and 0.75% bupivacaine at 37 degrees C. The inocula from the suspensions were cultured for 48 h at 37 degrees C. RESULTS: The 1- through 24-h exposures of 4 strains of S. aureus to 0.5% bupivacaine at room temperature reduced the colony count by 21.7%, 34.7%, 51.1%, 65.6%, and 81.1%, respectively, and the exposure at 37 degrees C reduced the count by 34.1%, 50.8%, 66.3%, 94.5%, and 96.0%, respectively. The differences were significant at all exposure times (P < 0.001, respectively). No organisms grew in the strain of E. coli after 24-h exposure and in the strain of S. epidermidis after 12- and 24-h exposures at 37 degrees C. The percent change from controls in the strains of E. coli and S. epidermidis was significantly higher than that in the strains of S. aureus at all exposure times at room temperature and 37 degrees C (P < 0.0001, respectively). Higher concentrations of bupivacaine were associated with lower colony count. CONCLUSION: Our results show that preservative-free bupivacaine possesses a temperature- and concentration-dependent bactericidal activity, and S. aureus is more resistant to the bactericidal activity of bupivacaine than are S. epidermidis and E. coli.

We report a rupture of the left main-stem bronchus following the insertion of a left-sided double-lumen endobronchial tube in a 76-yr-old woman with a short trachea. A fiberoptic bronchoscope was not used during the initial insertion of the tube and the depth of insertion resulted in approximately 5 cm in excess of the optimal level for this patient. The rupture had been caused by the tracheal portion of the double-lumen tube. This damage may have been avoided if a fiberoptic bronchoscope was used routinely as an introducer and for positioning of the endobronchial tube under direct vision.

We report a case of a broad prolapse in the posterior leaflet successfully treated by a mitral valve repair by the sliding leaflet technique. The mitral valve regurgitation was caused by a rupture and elongation in the chordae supporting the middle scallop. First 3 cm of the leaflet was quadrangularly resected, then the posterior leaflet was detached from the annulus. Suture annuloplasty of that portion was performed and then the posterior leaflet was reattached to the annulus. Finally a Carpentier-Edwards annuloplasty ring was sutured in position. A postoperative study revealed no regurgitation. The sliding leaflet technique seemed to be effective to reduce tension in the isovolumic stress area caused by covering the broad gap left by the resected leaflet. When mitral valve repair by the sliding leaflet technique is performed, we recommend the use of an annuloplasty ring to decrease the stress on the suture line, to remodel the annular configuration and to prevent annular dilatation.

A case of 31-year-old man with ruptured aneurysm of the sinus Valsalva into right atrium originating from noncoronary sinus (Konno's classification type IV) was presented. Patch closure of the defect was carried out through aortotomy followed by resection and direct closure of the aneurysm from right atrium. When placing the patch, pledgetted mattress sutures were passed to the aortic annulus from left ventricle to aorta. It could avoid distortion of aortic valve cusp. Attempting surgical treatment for this type of aneurysm, repair of the defect should be performed through aortotomy to ensure the repair and avoid recurrence of aneurysm, injury to aortic valve and conduction system. Repair from aorta is mandatory, and it is also necessary to open right atrium for the exact inspection of tricuspid valve.

A 59-year-old man was admitted to hospital with sclerodactyly and high grade fever. He complained of wrist joint pain and swelling of bilateral hands. Despite of administration of non steroid anti-inflammatory drug and steroid the symptoms were progressive and sclerodactyly spreaded to the forearm. Through the results of the laboratory examination, he was diagnosed as progressive systemic sclerosis (PSS). Chest CT scan showed an anterior mediastinal tumor, and histological examination revealed a spindle cell type thymoma with mild lymphocytic infiltration. During hospitalization, the pulse therapy of steroid was administrated. Progressive sclerodactyly and interstitial pneumonia were improved, but stiffness of hand and joint pain was not diminished. In expectation of improvement of the symptoms, mediastinal tumor was removed. Histological diagnosis was thymoma of epitherial type. After surgery, symptoms decreased and at last diminished, dosage of steroid could be tapered.

Chronic traumatic thoracic aneurysm which had passed over eighteen years since injury was reported. A 41-year-old man, who was involved in automobile accident 18 years before, complained back pain and was referred to our hospital for an aneurysm at the aortic isthmus. According to his history of trauma and location of aneurysm, it was diagnosed as chronic traumatic thoracic aneurysm. Graft replacement was performed under the left heart bypass by using the BioMedicus centrifugal pump. He has been doing well after the operation.

We evaluated, as an index of thermoregulation and hemodynamics, the validity of deep body thermometry that measures deep tissue temperature transcutaneously by creating an area under an insulated thermistor probe of zero thermal flow between skin and subcutaneous tissue in 27 patients undergoing cardiac surgery. Deep body temperatures (DBT) were measured at the forehead (FH) and palm (P), and the DBT gradients (DBTFH-P) were compared with simultaneously measured mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance (SVR), the gradients (TESODBTP, TRECDBTP) of the esophageal and rectal temperatures and palm DBT during a three hour period after discontinuing cardiopulmonary bypass. Among the body temperature and hemodynamics measurements, the closest linear relationship was found between DBTFH-P and TESODBTP [0.35 + 0.95 x TESODBTP (degrees C), r = 0.98, SEE = 0.45, P0.0001]. There were no correlations between DBTFH-P and MAP, CI and SVR. We conclude that the measurement of DBTFH-P is useful as a reliable non-invasive method of monitoring core and shell temperature to evaluate thermoregulation.

Compensatory vasoconstriction in an upper extremity during lumbar epidural anesthesia contributes to the stability of hemodynamics. We measured blood flow of an index fingertip (FBF) with laser-Doppler flowmetry, surface temperature of a middle fingertip (FT), deep body temperature of the forehead (HDT) and a big toe (BDT) by an insulated thermistor probe of zero thermal flow between skin and subcutaneous tissue, and mean arterial pressure (MAP) in 16 patients undergoing elective lower abdominal surgery under lumbar epidural anesthesia. Epidural puncture was done at L1-2 (n = 2), L2-3 (n = 8) or L3-4 (n = 6), and the initial dose of 13 +/- 1 ml (mean +/- SD) of 2% plain mepivacaine (n = 14) or 2% plain lidocaine (n = 2) was injected five minutes after the test dose of 3 ml. Five minutes after the initial injection, the hypesthesia region of cold sensation examined by alcohol absorbent cotton was T9 +/- 3 (range, T2-T12) at the upper limit and S2 +/- 2 (range, L2-S3) at the lower limit. After determination of the hypesthesia region, a combination of butorphanol 1.0 +/- 0.1 mg and midazolam 2.0 +/- 0.9 mg or diazepam 7.5 +/- 2.5 mg alone was administered intravenously. The difference between HDT and BDT decreased significantly from 6.4 degrees C (P0.01) at the time of test dose injection to 0.4 degrees C (P0.001) 20 minutes after the initial dose injection of local anesthetics. FBF showed a twofold significant increase (P0.01) 20 minutes after the initial dose injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1986 and 1989, 14 patients undergoing cystectomy for bladder cancer, in pathological stage high risk pT2 group, pT3-4 and/or with N+ disease, received postoperative adjuvant methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Of the 14 patients 10 were alive with no evidence of disease for an average of 41 months. Tumor recurrence was seen in 4 patients (bone in 2, lungs in 1, brain in 1 patient). Of the 4 patients, 3 patients died of cancer progression at an average of 26 months and 1 patient was alive with tumor for 30 months. Their actual survival rate at 64 months was 70%, which was significantly higher than that of the historical control groups (1974-1981: 18%, 1982-1985: 46%). Although postoperative adjuvant M-VAC chemotherapy for invasive bladder cancer seemed effective in this study, a controlled randomized study will be necessary to conclude if it could be of real benefit for these patients.

The "afterdrop" in body temperature (TEMP) following adequate rewarming from hypothermic cardiopulmonary bypass (CPB) is frequently observed. This temperature drop sometimes accompanied by shivering results in increased myocardial oxygen demand. We investigated the relations between the afterdrop and use of vasodilators after CPB. For vasodilator therapy, PGE1 at the rate of 0.025-0.088 microgram.kg-1.min-1 (Prostaglandin Low Doses, PLD; n = 8), 0.107-0.136 microgram.kg-1.min-1 (Prostaglandin High Doses, PHD; n = 7), or phentolamine at 4.1-5.9 micrograms.kg-1.min-1 (PHENT; n = 8) were intravenously infused in 23 adult patients after CPB. During three hour period after CPB, esophageal, rectal, and forehead TEMP are lower in PHENT than in PGE1 groups. There were significant differences between PHD and PHENT group. Finger tip TEMP was lower in PGE1 groups than in PHENT group. There were significant differences between PHD and PHENT group. There were no differences in systemic arterial pressure, cardiac index (CI) and systemic vascular resistance (SVR) at any point between PHD and PHENT groups. It is concluded that PHENT increases the peripheral skin blood flow and TEMP but decreases the visceral TEMP possibly due to vasodilatation of the skin vessels, while PGE1 decreases skin blood flow and TEMP but increases the visceral TEMP, although SVR clearly decreases at the same rate in the two groups.

A clinical and histopathological investigation was made on 170 patients with bladder cancer who underwent total cystectomy at our institutions between 1982 and 1986. The overall 5-year survival rates of patients with pTis + pTa, pT1, pT2, pT3, pT3b and pT4 were 100, 71.8, 60.7, 39.2, 31.4 and 0% respectively, those of patients with G1, G2 and G3 were 100%, 67.6%, 35.7% respectively. As for histopathological growth and spread pattern (INF), intramural lymphatic invasion (ly) and venous invasion (v), INF beta, INF gamma, ly2, v (+) showed the worst prognosis. These histopathological factors were considered to be closely correlated to each other. Studies on these histopathological factors are very important in planning the subsequent therapy.

Three cases of postoperative pulmonary lobe torsion were reported. Two of three showed hemorrhagic infarctions, and as a result underwent rethoracotomies and removal of the affected lobes. From these experiences, we consider that computed tomography (CT) and bronchofiberscopic examinations are useful for the diagnosis of advanced torsion.

Vasodilators expedite the rewarming process and facilitate weaning from cardiopulmonary bypass (CPB). We continuously infused prostaglandin E1 (PG-E1) at 0.02-0.05 microgram.kg-1.min-1 (n = 11) or phentolamine (PHENT) at 5-10 micrograms.kg-1.min-1 (n = 13) during rewarming from mild hypothermic CPB. Rectal temperature was 33.3 +/- 1.7 degrees C in PG-E1 group vs. 31.3 +/- 1.3 degrees C in PHENT group at 30 minutes, and 34.0 +/- 1.2 degrees C vs. 32.7 +/- 1.1 degrees C at 40 minutes from the start of rewarming. There were significant differences (P less than 0.01 at 30 min, P less than 0.05 at 40 min) in rectal temperature between the two groups. There were no differences in perfusion index of CPB, arterial perfusion temperature, mean arterial pressure, systemic vascular resistance as well as esophageal, forehead or palm skin temperatures at any point between the two groups. The required time for weaning from CPB was significantly shorter in PG-E1 than in PHENT group (P less than 0.01, 36 +/- 8 min vs. 46 +/- 11 min). Our results also strongly suggest that PG-E1 preferentially improves splanchnic blood flow.

Although epidural catheterization has many advantages in anesthesia and in the treatment of acute pain, spinal epidural abscess is a serious complication after the procedure. Since it is presumed that the epidural space is contaminated by bacteria on the skin via the space around the catheter, it seems important to clarify bacterial re-growth after application of skin disinfectant. Therefore, bacterial growths on human back 1, 2 days, and 1 week after application of disinfectants were studied in summer and winter to elucidate whether there are differences between the two seasons. Four disinfectants, 0.5% chlorhexidine in 80% ethyl alcohol (CA), 0.2% benzalkonium in 80% ethyl alcohol (BA), 10% povidone iodine (PI), and 80% ethyl alcohol (EA) were applied on the back of 76 adult healthy volunteers, and the specimens were taken by agar-contact method. The frequencies of positive cultures for bacteria were higher in summer than in winter. The frequencies of positive culture in summer after the applications of CA, BA, PI, and EA were as follows, respectively: 50%, 20%, 5%, and 40% after 1 day; 47%, 50%, 60%, and 50% after 2 days; and 82%, 82%, 70%, and 64% after 1 week. In winter, these frequencies after the application of CA, BA, PI, and EA were as follows, respectively: 0%, 0%, 18%, and 18% after 1 day; 5%, 26%, 32%, and 58% after 2 days; and 21%, 21%, 32%, and 42% after 1 week. We conclude that when an epidural catheter is in situ, more frequent skin disinfection has to be carried out, preferably by CA, in summer than in winter, since the presence of sweat on the back seems to hasten the re-growth of bacteria.

Of 52 male bladder cancer cases treated with radical cystectomy, 12 cases (23.9%) were incidentally diagnosed as stage A prostatic cancer. Histological analysis was done according to the "general rules for clinical and pathological studies on prostatic cancer." The average age of the prostatic cancer cases was 62.0 years with a range of 50 to 78 years. Three cases were of well differentiated adenocarcinoma, and 9 cases were of moderately differentiated adenocarcinoma. Six cases were at pT1, 3 at pT2, and 3 at pT3. One case was stage A1, and 11 were stage A2 cases. Perineural and capsular invasions were found in 3 cases each. Neither lymphatic nor vascular invasion was found in any case, and no evidence of seminal vesicular, urethral, bladder and rectal invasion was found in any case. Lymph node metastasis was not found in any of the 3 pelvic lymph node dissected cases.

Four cases of urachal carcinoma are presented. The first case was a 36-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiation therapy were performed. Histological findings showed a well differentiated adenocarcinoma. He has been well for twelve years postoperatively. The second case was a 52-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. Partial cystectomy and postoperative radiochemotherapy were performed. Histological findings showed a moderately differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The third case was 70-year-old man who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed multiple tumors at the dome of the bladder, internal urethral orifice and right lateral wall. Total cystectomy, ureterocutaneostomy and postoperative chemotherapy were performed. Histological findings showed a poorly differentiated adenocarcinoma. He died of a recurrent tumor 30 months after operation. The fourth case was a 68-year-old woman who was admitted with the chief complaint of macrohematuria with mucinous debris. Cystoscopic examination revealed a single tumor at the dome of the bladder. CT scan demonstrated a mass with calcification extending from the bladder dome superiorly. Partial cystectomy and postoperative chemotherapy were performed. Histological findings showed a well differentiated adenocarcinoma. She has been well for three months postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural cell-mediated cytotoxicity against NK-resistant target tumor cells was found in the peripheral blood of tumor-bearing patients approximately 1 mo after combined chemotherapy. The recognition specificity of these effector cells was broad and had no restriction. From the experiments of negative selection with mAbs and complements, these newly developed killer cells after chemotherapy were thought to be LAK-like cells. Contribution of these LAK-like cells to the mechanism of action of anticancer drugs remains to be clarified.

To investigate the mechanism of Bacillus de Calmette Guérin (BCG) bladder instillation therapy, the killer cell activity induced in peripheral blood mononuclear cells (PBMNCs) after BCG instillation was examined. Significant cytotoxic activity against natural killer (NK) cell resistant target tumor cells was detected after 3 days of instillation. To characterize this BCG induced cytotoxic activity further, human PBMNCs were cultured with BCG in vitro. From 24 h maximum cytotoxicity was obtained and continued for 3 days, then decreased slightly. Neither a DNA synthesis inhibitor Cytosine-arabinoside (Ara-C) nor a cytotoxic T cell (CTL) generation inhibitor Cyclosporine A inhibited this killer cell activation. Monoclonal antibody treatment revealed that both precursor and effector cells are Leu1-, 3a-, 7+, 11b+. The recognition specificity from cold target competition experiments was selective. Taken together NK type precursor was activated with BCG into NK type effector which has wider spectrum of target cells than usual NK cell.

Thirty-two patients with chronic prostatitis were given 6 tables of Cernilton daily for 12.6 weeks on the average. Improvement of subjective symptoms and objective findings was noted in 74.2% and 65.6% of the cases, respectively. The effective rate was 75.0%. No subjective symptoms or abnormal changes in laboratory data were observed in any case after Cernilton medication.