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We examined the anesthetic management for Fontan procedure performed without the use of cardiopulmonary bypass (Group N, n = 7) and that for equivalent procedure under cardiopulmonary bypass (Group E, n = 10) retrospectively. In Group N, surgical repairs of major vascular system were performed while bypassing the superior or inferior vena cava to the right atrium. The use of anesthetics and vasoactive agents was similar in both groups. Patients in Group N had significantly less blood loss and were extubated significantly earlier than those in Group E. However, significant metabolic acidosis was noted in Group N when reconstruction of the vascular system was completed and so-called Fontan circulation was initiated. Fontan procedure without the use of cardiopulmonary bypass may have advantage of less impairment for the cardiac performance and the pulmonary vasculature. However, its anesthetic management is another challenge to the anesthesiologist and requires meticulous control of both optimum preload and vascular resistance of the pulmonary artery.

Of 161 patients with blunt thoracic injury, 135 were male (83.9%) and 26 were female. The most common cause of injury was traffic accidents (130 patients, 80.7%), followed by falls (22 patients), and crushing (7 patients). There were 46 third decade and 36 second decade patients. Thirty-two patients had single thoracic injury and the other had multiple organ injury. The most common associated injury was head injury (65 patients). Most traffic accidents involved motor cycle accident. Forty-four patients died, 32 within 24 hours, and 4 died to thoracic injury. These 4 patients were shock on arrival and died within 24 hours. The injury severity score, which was under 30 in 78.3% of patients, correlated to the mortality rate. Rib fracture was the most common thoracic injury in 96 patients followed by hemothorax in 91, pulmonary contusion in 79, and pneumothorax in 64. Most of the thoracic injuries were treated conservatively. Thoracotomy was performed in 6 patients. Other than one patient with rupture of the left pulmonary vein, 5 patients recovered. Continued bleeding at a rate of more than 200 ml/h from the chest drainage tube or no recovery from shock and large air leakage preventing re-expansion of the lung are indications for emergency thoracotomy. Thoracotomy should also be considered after conservative treatment in patients with continued air leakage or intrabronchial bleeding negatively affecting respiration. Indications for thoracotomy should be determined individually based on evaluating of vital sign.

A study was conducted to evaluate the outcomes of 79 patients with early stage lung cancer diagnosed according to the following criteria. Central tumors were located in the segmental bronchi, or more proximally, and tumor invasion was limited to the bronchial wall without lymph node or distant metastases. Peripheral tumors were located distal to the subsegmental bronchi and were less than 2 cm in greatest dimension, and invasion was limited to the visceral pleura, with no lymph node or distant metastases. The 5-year survival rate was 100% for patients with peripheral type early squamous cell carcinoma, 94.6% for those with central-type early squamous cell carcinoma, and 79.3% for those with early adenocarcinoma. The 5-year survival rate for patients with central-type squamous cell carcinoma without pericartilage layer invasion was 97.0%, and that for those with T1N0M0 peripheral squamous cell carcinoma was 100.0%. To define early stage lung cancer as curable, it should be defined as T1N0M0, peripheral squamous cell carcinoma, or central squamous cell carcinoma without pericartilage layer invasion. For other histologic types, some added parameters are needed. The rate of multiple lung cancers was 10.1% and that of multiple primary malignant disease was 13.9%. Thus, careful followup of patients with early stage lung cancer should be carried out, as second malignancies in the lung and elsewhere are commonly detected.

Male F-344 rats were exposed by inhalation to gaseous formaldehyde at 0.3, 2, and 15 ppm 6 h/day, 5 days/week for 28 months. Nasal tumors were macroscopically evident in the 15 ppm group from the 14th month and 8 of 32 rats bore such tumors at the 24th month. Histopathological examination revealed both squamous cell papillomas and carcinomas. No nasal tumors were observed in the lower exposure groups (0.3 and 2 ppm groups). In the high exposure group (15 ppm group), frequent face washing, coughing and/or crouching position, lacrimation, nasal discharge, and yellow discoloration of the haircoat were observed. Significant decrease in food consumption and body weight was noted, and 20 (88.3%) rats died by the 24th month. Reduced triglyceride levels and liver weights, presumed to be related to the drop in food intake, were also seen in the 15 ppm group. Epithelial cell hyperplasia, hyperkeratosis, and the squamous metaplasia were apparent in all exposure groups. Inflammatory cell infiltration, erosion or edema were evident in all groups, including the 0 ppm and room (RC group) controls. In this study, a no effect level of formaldehyde vapor could not be obtained because toxicological signs were obvious even with the low exposure group. The benchmark doses for squamous metaplasia and epithelial hyperplasia were 0.25 and 0.24 ppm, respectively.

The sickle-cell gene is most concentrated in West Central Africa, the northeast corner of Saudi Arabia and East Central India. Sickle cell trait is the heterozygous condition for Hb S gene. Thirty to fifty per cent of their hemoglobin is Hb S and the remainder is Hb A. The sickle-cell crisis is induced by hypoxia, hypercarbia, acidosis, low flow condition, and hypothermia, which leads to vasoocclusion. A 39-year-old black man from Burkina Faso located in West Africa with left ventricular rupture was admitted for operation using cardiopulmonary bypass (CPB). He had been diagnosed as sickle-cell trait. The Hb S concentration was 36.2 per cent before operation with hemoglobin electrophoresis. During CPB, the minimum blood temperature was 31 degrees C and an aortic cross-clamp was not done. Total CPB time was 1 hour 31 minutes. Use of vasodilator and hyperventilation was effective. No neurological sequelae were observed.

Histopathological and biochemical examinations of the nasal cavity and lungs of rats inhaling 145.6 ppm (high-dose) or 15.0 ppm (low-dose) formaldehyde vapor for 6 h revealed dose-related damage. The contents of non-protein SH groups (NPSH) in the nasal mucosa and lung, and lipid peroxide (LPO) in the nasal mucosa were decreased, whereas LPO was increased in the lung. The contents of triglyceride in the lung tissue and lavage, and free cholesterol in the lung were decreased, providing evidence of a suppression of surfactant production. Exposure-related changes in the nasal turbinates, trachea, and lung included hyperkeratosis of the squamous epithelium, increased secretion, and desquamation of ciliated and mucosal cells. Under the present experimental conditions, 145.6 ppm formaldehyde vapor was found to strongly affect the exposed tissues. Changes in lipid peroxide were dependent on the level of exposure.

We report herein the case of a 59-year-old asymptomatic man who was referred to our department for investigation of an abnormal shadow detected on a routine chest roentogenogram. Computed tomography (CT) showed an infiltrative shadow and air bronchogram in the right middle lobe without mediastinal lymphadenopathy, and a right middle lobectomy was performed with hilar and interlobar lymph node excision. Microscopically, the tumor consisted of small lymphoid cells without atypia, admixed with neutrophils and other mononuclear cells, but there was no invasion of the bronchial cartilage or visceral pleura, or any lymph node involvement. Most of the tumor cells were positive for L26 and some for UCHL-1. Although a germinal center was not seen, pseudolymphoma could not be ruled out. Southern blot analysis of the frozen tissues revealed clonal rearrangements of the immunoglobulin heavy-chain JH and light-chain J kappa, whereby the tumor was diagnosed as malignant lymphoma of the small lymphocytic B-cell type. Thus, when such lymphoproliferative diseases which are difficult to diagnose are encountered, frozen tissue should be preserved for genetic analysis.

A case of double primary lung cancer was reported, one of which was peripheral type of adenocarcinoma of the right lung and the other was central type of squamous cell carcinoma of the left. A 66-year-old male was referred to our hospital on Nov. 2 1991, because a coin lesion at the right S1 was pointed out on chest X-ray. On bronchoscopy, a nodular tumor at the orifice of the left B3 was unexpectedly found. Biopsy of the left B3 tumor and washing cytology of the right B1 led to a diagnosis of left moderately differentiated squamous cell carcinoma (clinical T1N0 M0) and right adenocarcinoma (clinical T1N0M0). A right upper lobectomy was first performed with R2 lymph node dissection on Nov. 25 1991. Post-operatively, it was confirmed that the lesion was histologically poorly differentiated adenocarcinoma of the right S1, and the pathological stage was T2N0M0. Two weeks after the operation, chemotherapy of CDDP, VDS and MMC was given because of suspicion of rapid metastasis to the left hilar lymph nodes. Left upper lobectomy with R2 dissection was performed 7 weeks after the initial operation. Pathological findings showed squamous cell carcinoma originating from B3 with inflammatory lymphadenopathy and pathological evaluation was T1N0M0. He was discharged after an uneventful course of 3 weeks after the second operation. There are many reports that limited operations are recommended for each lesion in double primary lung cancer to reserve the pulmonary function. However, limited interventions cause frequently local metastasis, especially in peripheral type adenocarcinoma more than 3 cm in diameter and central type squamous cell carcinoma with lymph node metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

We studied the relationship between quantity of microbubble retained in the left heart and neuropsychologic alterations after surgery in 21 patients undergoing cardiac surgery including cardiopulmonary bypass. The neuropsychologic change was evaluated by three kinds of psychological test, which mainly analyzed memory and cognition. The microbubble was continuously monitored by the long axis view of the descending aorta of transesophageal echocardiography and then quantitatively analyzed and graded by the on-line computer. More microbubbles were detected in the valve surgery requiring the intracardiac procedure than in coronary artery bypass grafting and neuropsychologic deterioration, although the relationship did not reach statistical significance. Since most of the microbubbles were detected during the unclamping of aorta and the weaning from cardiopulmonary bypass, a technical improvement of the surgical procedures could reduce them. We think that transesophageal echocardiography is useful for monitoring microbubbles during operation.

No reports have focused on neurological outcomes after open heart surgery of patients with infective endocarditis (IE) and neurological complications. We evaluated parameters related to anesthetic management and neurological outcomes. The subjects analyzed were 24 patients who had undergone valvular surgeries under hypothermic cardiopulmonary bypass from April 1978 to December 1990. The patients were divided into two groups according to the interval between onset of neurological complication and the time of operation: 1) acute group (within one month before the surgery: n = 11, 9.4 +/- 9 days; means +/- SD) and 2) chronic group (more than one month before the surgery: n = 13, 120 +/- 80 days). After heart surgery, 5 patients in the acute group showed newly developed neurological abnormality including death from hemorrhagic transformation, hemiplegia or aphasia. No patients in the chronic group had newly developed neurological abnormality related to the surgery. In the neurologically deteriorated patients of the acute group, interval from the onset of neurological complication to surgery was 3.5 +/- 4.5 days, whereas that of the remainders of the acute group was significantly longer (14.4 +/- 9.0 days). Intraoperative events and anesthetic management of these patients were also analyzed. However, there were no significant differences in the parameters such as cerebral perfusion pressure, arterial PaCO2, doses of anesthetics and use of vasopressors. Our results suggest that the most important factor which may influence neurological outcome was the interval between the onset of neurological abnormality and the time of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

A confirmatory familiarization study of the Combined Repeat Dose and Reproductive/Developmental Toxicity Screening (ReproTox) test protocol proposed by the Organization for Economic Cooperation and Development (OECD) was performed using nitrobenzene, a testicular toxicant. The agent was given daily by gavage to groups of 10 male and 10 female Sprague-Dawley rats at doses of 100, 60, 20 and 0 mg/kg body weight. Some of the high dose animals exhibited neurological signs, and two males and 9 females died. Hemolytic anemia due to methemoglobin formation was evident in treated males. Histopathologically, treated males showed atrophy of seminiferous tubules of the testis, reactive changes secondary to hemolytic anemia in the hematopoietic organs, and hepatocellular swelling. Cerebral gliosis was observed in middle and high dose males. Male fertility was not affected. The body weights of pups from treated dams were lowered, and their postnatal loss was increased. Most of the known toxicological properties of this chemical was demonstrated in the present study, with the exception of reduced fertility. Therefore, the ReproTox protocol was concluded as being useful as a screening test of existing high production volume chemicals. It should be noted that while the reproductive toxicity test alone is insensitive for detection of male fertility disturbances associated with testicular toxicity, the latter easily be distinguished on morphological grounds.

Peripheral tissue oxygenation was monitored with near infrared spectrophotometry during abdominal or common iliac aortic cross-clamping surgery. Six patients who had abdominal aortic aneurysm (AAA) and eight patients who had aortic sclerotic occlusive disease (ASO) were studied. At the beginning of cross-clamping, oxyhemoglobin was decreasing and deoxyhemoglobin was increasing in all AAA patients. Average of 37 minutes following cross-clamping of abdominal aorta, both hemoglobin values were stabilized. On the other hand, changes in both hemoglobin values were delayed or missing in ASO patients. The results suggest that the duration from cross-clamping to stabilization is related to co-lateral blood flow. During operation, monitoring of peripheral blood flow with near infrared spectrophotometry is useful for detection of peripheral ischemia and for the estimation of postoperative local blood flow.

Recently, bladder temperature (BT) monitoring is employed instead of rectal temperature because it is possible to keep the probe clean. The relationship between BT and core temperature is different in patients with steady state compared with those with rapid changes in temperatures. This study evaluated BT compared with nasopharyngeal temperature (NPT) reflecting brain temperature during cardiac surgery with induced hypothermia using cardiopulmonary bypass. During the steady state, after induction of anesthesia and immediately before cooling or rewarming, BT was equivalent to NPT independent of urine flow rate. In rapid cooling or rewarming phase of cardiopulmonary bypass, BT was not equivalent to NPT. BT preceded NPT in case of a very high urine flow rate, and with a lower urine flow rate delayed BT lagged behind NPT. During rapid changes in core temperature during cardiopulmonary bypass, the difference of BT to NPT depends on urine flow rate.

In 31 patients undergoing coronary artery bypass grafting, we investigated the maintenance doses of pancuronium and vecuronium during hypothermic cardiopulmonary bypass. For all patients, the height of the first twitch of the train-of-four (T1) was measured with evoked electromyogram. During operation, T1 was kept from 5 to 15 per cent of control. Infusion doses of both muscle relaxants were controlled with a personal computer. During hypothermic cardiopulmonary bypass (body temperature 28 degrees C), requirement of both muscle relaxants decreased for about 90 per cent compared with pre bypass values. We consider that the prolongation of neuromuscular blockade is attributable to hypothermia rather than to other factors of cardiopulmonary bypass. After rewarming, maintenance dose of vecuronium remained about a half of the dose required in pre-bypass period. It suggests that elimination of vecuronium from liver and kidney is hindered not only during hypothermia but also after rewarming.

The authors attempted to estimate the relationship between three biological parameters (nuclear DNA content, PCNA (proliferating cell nuclear antigen)/cyclin, HER-2/neu oncoprotein) and lymph node metastasis. We evaluated 37 breast cancers which were less than 2 cm in maximum dimension. Quantitative analysis was performed using a CAS 200 Image Analysis System, after Feulgen staining and immunochemical staining using anti-PCNA/cyclin monoclonal antibody and anti-HER-2/neu oncoprotein polyclonal antibody. In lymph node-negative cases 20.0% were aneuploid, while in lymph node-positive cases 58.8% were aneuploid. A total of 20.0% lymph node-negative cases were in the high proliferation group, as opposed to 52.9% of lymph node-positive cases. This analysis revealed a significant relationship between cell proliferation and lymph node metastasis. Analysis of the expression of HER-2/neu oncoprotein revealed no significant relationship between overexpression of HER-2/neu oncoprotein and lymph node metastasis, but the expression of HER-2/neu oncoprotein was significantly related to a shorter relapse-free survival.

We report on the anesthetic management of eight patients undergoing unifocalization for pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries. Unifocalization was performed separately on the right and left lungs in the lateral decubitus position. During unifocalization, pulmonary blood flow to the nondependent lung is interrupted and arterial oxygenation is dependent solely on the blood flow to the dependent lung. Thus, PaO2 and SaO2 decreased significantly and PaCO2 increased significantly during unifocalization, as compared with before and after unifocalization. When these values are compared between first and second stage of unifocalization, SaO2 during second stage was lower than during first stage. Although PaO2, PaCO2, and pH during second stage tended to be worse than during first stage, the differences did not reach statistical significance. During unifocalization, especially in second stage, to prevent deterioration of these arterial gas variables, pulmonary blood flow had to be increased by frequent administration of catecholamine. In addition, bicarbonate infusion was also used to prevent progressive metabolic acidosis due to hypoxia during unifocalization. Because anticoagulant therapy was required during unifocalization, airway bleeding was a common complication.

A twenty-eight-day repeated dose toxicity test of Ajicoat at dose levels of 0, 0.05, 0.2 or 1.0% and Bionole at dose levels of 0.2, 1.0, or 5.0% in the feed was carried out in male and female Wistar rats. Three groups, at the dose levels of 1.0% of Ajicoat, 5.0% of Bionole and control groups, were used for investigation of recovery. No animals died during the administration period. There were no significant differences in body weight gain, food consumption and organ weight between the treated and control groups. No specific changes were observed in any parameters of hematological investigations. At doses higher than 1.0% of Ajicost and Bionole groups, a significant increase of BUN value in serum was observed in both sexes. The serum glucose value increased and NEFA value decreased in male at a dose of 1.0% of Ajicoat group. These changes observed at the end of the administration period were no longer detected after the recovery period, suggesting that these effects were reversible. On histopathological examination, no specific changes were observed in the Ajicoat and Bionole treated rats. Based on these results, the no-observed-effect level was 0.2% (174 mg/kg) for both Ajicoat and Bionole.

The gelatin-starch syrup microencapsulation method was applied to subacute toxicity studies of tribromomethane (TBM), dibromochloromethane (DBCM) and bromodichloromethane (BDCM). Groups of Wistar rats (7 males and 7 females) both sexes were given diet containing microcapsules of each of these trihalomethanes (THMs) at the following concentrations: TBM, 0.068, 0.204 and 0.612% in males, and 0.072, 0.217 and 0.651% in females; DBCM, 0.020, 0.062 and 0.185% in males, and 0.038, 0.113 and 0.338% in females; BDCM, 0.024, 0.072 and 0.215% in males, and 0.024, 0.076 and 0.227% in females. Suppression of body weight gain was seen in each high-dose males fed TBM or BDCM and females fed DBCM or BDCM. Histopathologically, hepatic lesions such as vacuolization and swelling of liver cells were significantly noted in both sexes of all groups fed TBM, in both sexes of the middle- and high-dose groups fed DBCM, and in males of the high-dose group and in females of the middle- and high-dose groups fed BDCM. In addition, single cell necroses were observed in males and females fed DBCM and in males fed BDCM. Hepatic cord abnormalities were also noted in males of the high-dose group fed BDCM. Although no increases in serum transaminase activities (ASAT, ALAT) were evident in either sex fed any of the THMs, decreases in triglyceride content, cholinesterase and lactate dehydrogenase activity were observed. Renal lesions reported to occur in gavage studies were not found in the present feeding study. Lowest-observed-adverse-effect-level (LOAEL) of TBM and no-observed-adverse-effect-level (NOAEL) of DBCM and BDCM were determined to be 56.4 mg/kg, 18.3 mg/kg and 20.6 mg/kg, respectively, under the present experimental conditions.

To prevent brain damage during cardiopulmonary bypass (CPB), adequate cerebral perfusion for cerebral oxygen demand should be maintained. We monitored jugular venous oxyhemoglobin saturation (SjO2), which reflects the overall balance of cerebral oxygen supply and demand, continuously in 12 patients undergoing cardiac surgery. We examined whether this balance is disrupted during CPB, and if so, analyzed critical factors that affect this phenomenon. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO2 did not change, and it was stable during the hypothermic period of CPB. On the other hand, a significant reduction in SjO2 was observed during the rewarming period, and SjO2 had an inverse linear correlation with nasopharyngeal temperature. Furthermore, the percent decrease of SjO2 was significantly related to "rewarming speed" (an average increase in temperature per minute). Our results indicate that temperature change during the rewarming period is a critical factor affecting the balance of cerebral oxygen supply and demand during CPB.

We investigated the effect of prostaglandin E1 (PGE1)--induced hypotension during sevoflurane anesthesia on the cerebral blood flow (CBF), autoregulation and internal jugular venous O2 tension (PjO2) in 8 patients undergoing neurosurgery. Although the mean arterial pressure decreased from 95.3 +/- 3.8 mmHg (mean +/- SD) to 63.6 +/- 8.0 mmHg by continuous intravenous infusion of PGE1, CBF did not change significantly (97.2 +/- 10.6% of control value). During hypotensive anesthesia, autoregulation was well maintained in all patients, and the values of PjO2 did not suggest brain hypoxia at all. The results indicate that hypotensive anesthesia induced by PGE1 and sevoflurane is a safe and a reliable method for neuroanesthesia.

Central venous catheterization for pressure monitoring and drug administration is often important in the anesthetic management of infants undergoing cardiovascular surgery. We examined the effects of patient age, weight, and central venous pressure and the experience of the anesthesiologist on the rate of successful catheterization and catheterization time of the internal jugular vein (IJV) in a prospective study. We studied 106 infants undergoing IJV catheterization for cardiovascular surgery over a 7-mo period at our institution. We catheterized the IJV by the high approach. The direct venipuncture or the Seldinger method was used according to the patient's weight. Overall successful catheterization rate was 97.2%, and the average catheterization time was 353 +/- 21 s (mean +/- SEM). Complications included arterial puncture in 12 cases (11.3%), hematoma formation in four cases (3.8%), and catheter malposition in two cases (1.9%), but pneumothorax was not observed. When a patient was younger than 3 mo or weighed less than 4.0 kg, successful catheterization rate decreased significantly to 81.3% and 78.6%, respectively. Catheterization time was inversely correlated with both age and weight, whereas central venous pressure did not affect either successful catheterization rate or catheterization time. We were unable to demonstrate that the experience of the anesthesiologist plays a significant role in the success or complication of the catheterization procedure. Our results indicate that IJV catheterization by the high approach is a reliable and useful technique in infants, and that the weight and age of the patient significantly influence the rate of successful catheterization.

A computerized anesthesia record system is in routine use for cardiovascular procedures in our operating rooms. This system is implemented on an NEC PC-9801 personal computer and automatically collects hemodynamic variables from a polygraph as well as from intraoperative laboratory reports via RS-232C ports. Events such as intubation can be entered manually using a standard keyboard. Since the introduction of the system in 1987, the system has been used in 90 percent of the total cases performed and 2941 electronic data files were recorded in a four-year period. Excluding some short procedures for which the system was not used, failure to store records on disks resulted from system errors due to power-line troubles in the operating rooms as well as users' omission to command the system. User-acceptance of event entry was poor. In 74 percent of the cases, not a single event was entered. Advantage of an automated anesthesia record system over a hand-written record is being recognized. Wide-spread use of such a system will require ergonomic design of the system and man-machine interfaces suitable for use in an operating room.

In order to study the chronic toxicity of 2, 4, 6-tri-tert-butylphenol (TTBP), groups of 40 Slc: Wistar rats of either sex were fed diet containing 0, 30, 100, 300 or 1000 ppm of TTBP for up to 24 months. Hematological, biochemical and histopathological examinations performed periodically revealed slight microcytic anemia, changes in some biochemical parameters relating to liver function and focal necrosis of liver cells following TTBP administration, and these changes observed in females were severer than those in males. No neoplastic responses following TTBP administration were noted. Noticeable changes were not observed in the 30 ppm group throughout the experimental period. Thus, it was concluded that TTBP causes liver injury characterized by focal necrosis with microcytic anemia and elevations of serum phospholipids and cholesterol levels presumably occurring as secondary effects following the liver injury.

Leukocyte-depleted blood products are currently a burning issue in transfusion medicine. As methods for depleting leukocytes, the bedside filters are shown to have a high removal rate and several kinds of them are in use. We investigated the leukocytes removal rate of a new filter RC-100 (Pall Co., Glen Cove, NY) under the condition of rapid rate of transfusion during operations. In flow rates of 30, 60, 100 ml.min-1, the removal rate of leukocytes for CRC were 99.9 +/- 0.06, 100.0 +/- 0.00 and 99.4 +/- 0.20% respectively, and for WB 100.0 +/- 0.00, 99.9 +/- 0.10 and 99.1 +/- 0.70%, respectively. The recovery rates of erythrocytes were not significantly decreased for CRC and for WB in all flow rates. These results suggest that RC-100 could be useful either for CRC and for WB even with the rapid flow rate under 100 ml.min-1.

The anaesthetic management of a patient with phaeochromocytoma, tricuspid atresia and pulmonary vascular stenosis is reported. The patient received no preoperative preparation with adrenergic blockers. Anaesthesia was induced and maintained with fentanyl, diazepam and sevoflurane. Intraoperative blood pressure was controlled with sodium nitroprusside, sevoflurane, phentolamine, and propranolol. For hypotension after resection of the tumour norepinephrine was required. This patient did not have a systemic to pulmonary shunt procedure performed, so the maintenance of pulmonary blood flow in the presence of haemodynamic instability during operation for phaeochromocytoma was a major concern. Monitoring of oxyhaemoglobin saturation (SpO2) with a pulse oximeter was considered to be useful because SpO2 may reflect pulmonary flow. During serious haemodynamic disturbances due to the manipulation of the tumour, the heart rate was inversely correlated with SpO2, but the relationship between mean arterial pressure and SpO2 was weak. Therefore, control of heart rate appeared to be more important than control of blood pressure in this case.

We studied the usefulness of the OECD combined Repeat Dose and Reproductive/Developmental Toxicity Screening Test (ReproTox) using cyclophosphamide (CP), which is well known for its toxicological properties. CP was given daily by gavage to groups of 12 male and 12 female 8-week-old Sprague-Dawley rats at doses of 0, 2, 3, 4.5 or 6.7 mg/kg. Significant decreases in body weight and food consumption were observed in males given 6.7 mg/kg and in all treated females. One, 3 and 12 females died during pregnancy in the groups given 3, 4.5 and 6.7 mg/kg, respectively. In males 2 died in the 6.7 mg/kg group. Leukopenia and anemia were evident in treated males. The thymus and spleen weights were significantly decreased in treated rats. Histopathologically, atrophy of the thymus, spleen and bone marrow was observed. With respect to the reproductive/developmental toxicity, dose-dependent increases in postimplantation loss and postnatal death of pups were found in treated dams. The body weight of pups from treated dams was significantly lowered. Thus, most of the known toxicological properties of CP regarding systemic toxicity and reproductive/developmental toxicity were clearly demonstrated in this study. Therefore ReproTox can be considered a useful screening test for assessing repeat dose and reproductive/developmental toxicity of existing chemicals of high production volume, although teratogenic potential and adverse effects on spermatogenesis and fertility were not detected under the present experimental conditions.

A 64-year-old man with an early carcinoma of the remnant stomach that developed from a gastritis cystica polyposa (GCP) is presented, and the morphology and histogenesis of this rare condition are discussed. This patient had a Billroth II reconstructed remnant stomach for 25 years, and was referred to our attention because of cholecystocholedocholithiasis. In screening an upper gastrointestinal barium study and an endoscopy revealed an irregular-shaped, flat, polypoid tumor in a stoma of the posterior wall. The resected polypoid lesion measured 4.5 x 3.0 cm. A histological examination revealed it to be a well differentiated adenocarcinoma of the mucosal layer that had developed from a GCP.

One ml of 0.106%, 0.425% or 1.7% acetic acid (AA) solution, isotonic to physiological saline solution, was injected into the M. vastus lateralis of male Japanese white rabbits. Two, 7, 14 and 21 days after the injections, the rabbits were autopsied, and the removed muscles were observed macroscopically. After fixation with 10% neutral formalin, they were examined histologically. Hemorrhage and white degeneration of the muscles were grossly observed in 0.106%, 0.425% and 1.7% AA at 2 days. These lesions disappeared at 7 days and thereafter in 0.106% AA, and at 14 days and thereafter, except for one animal, in 0.425% AA. In 1.7% AA, these lesions were observed until 21 days, but gross hemorrhage began to recover at 21 days. The size of the lesion, which was expressed as a product of the major axis (mm) and minor axis (mm) of the lesion, showed reduction over time, especially in 1.7% AA. Histologically, swelling, necrosis and calcification of the muscle fibers and cell infiltration, hemorrhage and dilatation in the interstitium were observed after the injections of 0.106%, 0.425%, and 1.7% AA. At 7, 14 and 21 days, regeneration of the muscle fiber and fibrosis in the interstitium were observed. The injected sites were examined by injecting a chip of test-tube brush as a marker. In 20 (83%) of 24 cases, it was ascertained that the markers were injected into the M. vastus lateralis. The markers were found in the M. vastus intermedius in 3 out of 4 other cases and in the intermuscular tissue between the M. vastus lateralis and M. tensor fasciae latae in one case.

Spontaneous tumors of the nervous system and associated organs and/or tissues in 346 male and 346 female F344/DuCrj rats and 200 male and 177 female Slc:Wistar rats were examined. The main neurogenic tumors observed were gliomas and neurinomas, which were detected in both strains of rats. Out of 7 gliomas, 6 were found in the brain and 1 in the spinal cord, and out of 4 neurinomas, 2 were in the trigeminal nerves and the other 2 were in the spinal nerves. In addition, other types of tumors (2 granular cell tumors in the brain, 1 pinealoma, 3 ganglioneuromas in the adrenal gland, 1 undifferentiated carcinoma in the nasal cavity and 1 chordoma in the posterior neck region) were observed.

Bromocinnamic aldehyde (BCA), an antibacterial/antifungal agent, was tested for its chronic toxicity/carcinogenicity in female Slc:ddY mice. The animals received 0.25%, 1.0% and 4.0% of BCA dissolved in olive oil applied to the shaved back skin area twice a week for 79 weeks. The control group received olive oil alone under similar conditions. In addition to these animals, 5 animals in each group were killed at 6 and 12 months for investigation of the time-related toxic effect of BCA. A slight inhibition of body weight increase and a slight decrease in the survival rate were seen in the 4.0% BCA-treated group. No significant changes were observed in hematological parameters at 6, 12 and 18 months. In chemical biochemistry determination in the blood at 6 and 12 months, a significant decrease in non-esterified fatty acid and phospholipid values was observed in the experimental groups. Histopathologically, necrosis, scabbing, cell infiltration and thickening of the epidermis were noted at the site of application in the 4.0% BCA group. Moreover, extramedullary hematopoiesis and amyloid degeneration were detected in the spleen, while the incidence of adenomas in the lung decreased with a dose-response. These changes seemed to be the result of a non-specific inflammatory reaction to the irritation effects of the agent on the skin. No significant differences in the incidence of tumors were found between the control and experimental groups, not only at the site of application but also in other organs, although lung adenomas decreased dose-dependently in all treated groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous hyperglycemia, glycosuria, hypoinsulinemia, and glucose intolerance were observed in some WBN/Kob rats, at about 9 months of age, and in all at the age of 17 months. Females did not present this pathology. Histopathologic examination of the pancreas revealed severe changes in male rats at the age of 3 months. Between 3 and 6 months of age a distinct infiltration of inflammatory cells was found around islets and among adjacent acinar cells. At the same time, marked fibrosis was seen around the pancreatic ducts and blood vessels. With advancing age the fibrous tissue gradually invaded extensive areas of the pancreas where also the islets became involved in fibrotic degeneration. At 17 months of age and later, an obvious decrease in islet number and size (less than 50 mu in diameter) was observed, even in relatively unaffected areas of the organ. Frequent bilateral cataracts began to appear at about 15 months of age. Opacities were first observed in the periphery of the lens, then increased rapidly in intensity and extended centripetally. Nineteen-month-old male rats were hypersensitive to exogenous insulin, but showed no significant decrease in blood glucose level when treated with oral tolbutamide. These results suggest that these rats suffered from a decreased insulinogenic response.