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Pulmonary resection was performed for primary lung cancer of a 72-year-old patient which was associated with diffuse panbrochiolitis that required home oxygen therapy. The preoperative total pulmonary vascular resistance at rest was 564 dyne.sec.cm-5/m2, but thoracotomy and reduction surgery were possible by strict respiratory and circulatory control. The troublesome postoperative pulmonary phthisis was dealt with through extended control by means of total parenteral nutrition and use of the Heimlich valve.

The ability of dl-verapamil to enhance myocardial protection when given before, during, or after myocardial ischemia was assessed with the use of an isolated working rat heart model of cardiopulmonary bypass and ischemic cardiac arrest. Under conditions of normothermic ischemic arrest (30 minutes at 37 degrees C), the addition of verapamil enhanced the protective properties of the St. Thomas' Hospital cardioplegic solution. Optimal protection was observed with verapamil concentrations of 0.5 mg/L (1.09 mumol/L) of cardioplegic solution. Under these conditions, postischemic enzyme leakage was reduced by 32.2% and the postischemic recovery of aortic flow was improved by 18.7%. Despite the additional protection at normothermia, the drug at several concentrations appeared unable to improve functional recovery after an extended period of hypothermic arrest (150 minutes at 20 degrees C), although under these conditions its inclusion in the cardioplegic solution could substantially reduce enzyme leakage. In other studies, the ability of various doses of verapamil alone as a substitute for the cardioplegic solution was examined. At the optimal dose (again 0.5 mg/L), and under normothermic conditions, verapamil alone was a good protection against ischemic injury, although this protection did not match that afforded by the St. Thomas' Hospital cardioplegic solution. In similar studies under hypothermic conditions, the drug failed to afford tissue protection, perhaps indicating some common modality between hypothermia and verapamil-induced protection. Pretreatment with verapamil (0.1 mg/L) prior to ischemia offered moderate additional protection, but its use during reperfusion failed to enhance overall recovery.

Efficacy and limitation of barbiturate therapy employed as postoperative treatment for acute traumatic intracranial hematomas were studied in 20 patients. The clinical cases in this series included 15 males and 5 females with mean age of 41.8 years who all were operated on for intracranial hematomas within 3 days after injury. Glasgow Coma Scale (GCS) score was less than 7 in all instances and intracranial pressure (ICP) as well as arterial pressure was monitored postoperatively with Gaeltec and Gould transducers. Barbiturate therapy (5 mg/kg of thiopental as an initial dose and loading dose of 2-3 mg/kg/hour) was given when ICP rose above 20 mmHg and maintained for 3 days after operation. The outcome of the patients was assessed by Glasgow Outcome Scale 3 months after injury. The response of barbiturate on ICP and the changes of cerebral perfusion pressure (CPP) during the therapy in relation to the outcome were studied. Final outcome of the patients revealed 5 of good (good recovery and moderate disability), 3 of poor (severe disability and vegetative state) outcomes and 60% of mortality rate. Eleven out of 20 patients responded to barbiturate therapy and 0-20 mmHg of ICP reduction (mean reduction of 10 mmHg) was obtained in these cases. Among these cases, 2 out of 3 dead patients were older than 60 years. There were no responses of barbiturate in 7 patients to whom the therapy was started when ICP rose above 40 mmHg. No response of the therapy on ICP was also observed in the patients with GCS score of 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Using an isolated rat heart preparation as a model of cardiopulmonary bypass and ischemic arrest, a comparative study has been undertaken in order to characterize the functional, metabolic and electrophysiological consequences resulting from the addition of dl-verapamil or nifedipine to the St. Thomas' Hospital cardioplegic solution. Hearts (n = 6 in each group) were subjected to cardioplegic infusion with the St. Thomas' solution with or without added verapamil (1.1 micromoles/liter) or nifedipine (0.075 micromoles/liter). After 35 minutes of normothermic (37 degrees C) ischemic arrest, reperfusion was initiated and functional recovery was measured and expressed as a percent of its pre-ischemic control value. Inclusion of nifedipine in the cardioplegic solution improved the post-ischemic recovery of cardiac output from its control value of 59.8 +/- 3.0% to 80.0 +/- 2.5%. The temporal characteristics for the post-ischemic recovery of electrical activity and contractile performance were uncomplicated and similar to control hearts. Inclusion of verapamil also improved the protective properties of the St. Thomas' solution with cardiac output recovering to 76.8% +/- 2.8%. However, in contrast to the control and nifedipine groups, the profile for functional recovery was complex. After an early initial recovery, pressure development declined for 0.5 to 6.0 minutes. This occurred despite the recovery of electrical activity. Hearts then exhibited a second phase of recovery where pressure development returned to normal and this was sustained for the duration of the experiment. Analysis of electrocardiographic characteristics revealed a significant prolongation of the P-P and P-Q interval during the first 10 minutes of reperfusion in the verapamil group.(ABSTRACT TRUNCATED AT 250 WORDS)

Normal guinea pig serum lacking detectable antiviral antibody inactivated influenza B virus via the classical complement pathway. This virus inactivation appeared to result from the steric hindrance of HA activity by the association with the virus of serum proteins presumed to be complement components. Trypsin digestion of the associated proteins fully restored the HA activity but not infectivity. It was found that the virus underwent minor disruption of the envelope and degradation of M1 protein and genomic RNA.

Many experimental studies have shown that orthomyxo- and para-myxoviruses may be pneumotropic, but not enterotropic in mammals. On the other hand, these viruses are both pneumotropic and enterotropic in avian species. We have devised a new method for detecting virus receptor possessing cells (VRPC) in tissue sections. VRPC could be detected in the cells lining the airways of both mice and birds. The mode of distribution of VRPC in mouse digestive system differed remarkedly from that in avian digestive system. VRPC were not found in the epithelium of mouse digestive systems whereas the epithelium of bird digestive system were abundant in VRPC. When the large intestines from mice or duck undergoing laparotomy and inoculated directly into intestine with influenza virus were examined, viral antigen was detected in the epithelial cell of duck colon, but not in mouse intestines. From the study utilizing the new method, it could be concluded that the distribution mode of VRPC is one of the most important factors determining the virus tissue specificity.

For the creation of atrial septal defect (ASD), we have developed a new method (Method I) using modified Harken blade for the closed commissurotomy, in which the membranous septum of the fossa ovalis was incised in case of patent foramen ovale (PFO). When there was no or very narrow PFO, we applied Schuster's procedure to create defect in the muscular and membranous septum, however, it was sometimes found the bridging of remnant of membranous septum was left. So that, we have applied the Method I to cut it off (Method II). Up to date, eleven patients were operated with the Method I, and three patients with the Method II. As the results, nearly no pressure gradient between right and left atrium was detected postoperatively. In two cases, sufficiently created ASDs were confirmed at radical surgery. Because of the safety and reliability, our new procedures appear to be more advantageous in comparing to conventional Blalock-Hanlon or other procedures.

Clinical significance of multimodality evoked potentials (MEPs) consisting of auditory evoked brainstem response (ABR), cortical somatosensory evoked potential (SEP) and visual evoked potential (VEP) was studied in 14 cases with severe head injuries. The cases in this series associated with cerebral contusion and/or intracranial mass lesions such as acute subdural, intracerebral and acute epidural hematomas and Glasgow Coma Scale (GCS) score was less than 8 in all instances. MEPs were recorded for 14 days after injury and evaluated by MEP grade modified from Greenberg, et al. Intracranial pressure (ICP) was monitored from the extradural space on main lesion side in all cases for 3 to 5 days. Transtentorial herniation on CT scan was also graded according to the status of subarachnoid cisterns around the tentorium. The outcome was assessed by Glasgow Outcome Scale at 3 months after injury and was classified into good, poor and dead. MEPs on admission showed mild to severe abnormalities determined by single or all modalities in all cases and they were fairly well correlated with GCS score on admission and initial ICP. In the cases with good outcome, initial MEPs showed mild to moderate abnormalities determined by single modality and improved within 3 days after injury. They returned to normal or remained at mild abnormality at 7 days. But abnormality on initial MEPs was more severe in the cases with poor outcome and they were deteriorated within 3 to 7 days when elevation of ICP above 25 mmHg was observed. MEPs remained at moderate abnormality even at 14 days after injury in these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to clarify the mechanism of action of recombinant human leucocyte interferon, the effect of local injection of it to the human malignant gliomas (one oligodendroglioma, the other glioblastoma) transplanted into nude mice were evaluated. The volume of the tumors were calculated as 1/2 (short diameter [cm])2 x (long diameter[cm]). And the ratio of tumor volume (T)/original size (C) were calculated in terms of experimental day. Among the groups of control (vehicle of IFN injected), 1 million units of IFN locally injected group, 3 million units injected group, and 9 million units injected group, the effects of the treatment were statistically evaluated in terms of T/C. At the end of the experiment, each animal was injected 4 mg of BrdU intraperitoneally, and the labeling indices of the tumor tissue were measured and compared among the groups above mentioned. Local injection of IFN to the tumor was effective even at the dose of 1 million units every other day for 16 days for glioblastoma and 50 days for oligodendroglioma. The labeling index of the treated groups was significantly reduced when compared to that of control group in both tumors. And the experiment was performed to evaluate the variation of NK activity and ADCC activity of mouse spleen cells among the experimental groups. For the oligodendroglioma, NK activities were significantly increased in the 9 million units of IFN injected group when compared to those of control group. For glioblastoma, there was no definite variation of NK and ADCC activities among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The human lung carcinomas PR310 and PR371 contain activated c-K-ras oncogenes. The oncogene of PR371 was found to present a mutation at codon 12 of the first coding exon which substitutes cysteine for glycine in the encoded p21 protein. We report here that the transforming gene of PR310 tumor contains a mutation in the second coding exon. An A----T transversion at codon 61 results in the incorporation of histidine instead of glutamine in the c-K-ras gene product. By constructing c-K-ras/c-H-ras chimeric genes we show that this point mutation is sufficient to confer transforming potential to ras genes, and that a hybrid ras gene coding for a protein mutant at both codons 12 and 61 is also capable of transforming NIH3T3 cells. The relative transforming potency of p21 proteins encoded by ras genes mutant at codons 12, 61 or both has been analyzed. Our studies also show that the coding exons of ras genes, including the fourth, can be interchanged and the chimeric p21 ras proteins retain their oncogenic ability in normal rodent established cell lines.

External conduit repair was performed in 20 patients with "valved pericardial roll (VPR)" made of own pericardium (one case) or porcine pericardium (19 cases). Intraoperative measurement of peak pressure gradients across the valve ranged from 0 to 8 mmHg (mean 1), and that from the pulmonary ventricle to the pulmonary artery ranged from 0 to 38 mmHg (mean 20). Re-evaluation of 7 patients one year after surgery shows no increase in the pressure gradient except the first case, in which VPR was made of own pericardium. In pulsed Doppler echocardiographic study, no regurgitation was found in 4 patients, mild in 6, moderate in 4, severe in 1. VPR is functioning well with longest follow up at 16 months.

The efficacy of beclomethasone diproprionate aerosal (BDA) was studied in 27 steroid-dependent asthmatic children. In the double-blind portion of the study BDA was found to be superior to placebo. The benefits of BDA therapy were sustained through the two-year, open-label portion of the study. Adverse effects were few and minor. Transfer from oral corticosteroid therapy to BDA was carried out uneventfully and was not associated with untoward effects.

Before and one month after aortic valve replacement, the contractile state of the left ventricles in 10 patients with chronic aortic regurgitation were studied. The slope and intercept of the end-systolic stress-volume relationship (ESSVR) determined by M-mode echocardiography during intravenous infusion of Nitroprusside were used as an index of myocardial contractility. We found that the end-systolic wall stress-volume relationship from more than four points of pressure and dimension data have shown the linear relation for each subject with linear coefficients ranging from 0.848-0.997. There was no significant change in the slope of ESSVR between the pre- and early postoperative studies (1.66 +/- 0.37 to 1.92 +/- 1.02; p greater than 0.05), however, the intercept decreased significantly (44.7 +/- 32.4 to 29.4 +/- 28.0; p less than 0.01), which meant the leftward shift of the line of ESSVR and may imply the improvement of myocardial contractility. On the contrary, the fractional shortening decreased significantly (25.6 +/- 8.5 to 18.9 +/- 8.8%; p less than 0.01), reflecting marked reduction in preload or left ventricular end-diastolic volume (7.52 +/- 1.07 to 6.04 +/- 1.38; p less than 0.01). The change in the slope of the liner of ESSVR demonstrated that myocardial contractility might not be depressed at this time but rather improving.