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For the purpose of preventing suppuration of wounds of the oral cavity and throat, we attempted to develop a viscous solution of dibekacin sulfate (DKB) as a suitable medication. Solutions of different viscosity and antibacterial potency were prepared by mixing DKB, sodium carboxymethyl cellulose (CMC-Na), and water in varying proportions. Studies were then performed to ascertain relationships between the concentration of CMC-Na pH and viscosity, and between the viscosity and diffusion of DKB. The concentration of CMC-Na giving rise to optimal clinical efficacy was determined, and the concentration of DKB necessary for clinical treatment was estimated on the basis of the ionic binding constant between DKB and CMC-Na. As a result, the optimum CMC-Na concentration was found to be 2%, while the optimum DKB concentration was estimated to be 100 micrograms/ml.

A gauze tampon, which contains an ointment incorporating dibekacin sulfate, was prepared and investigated as a device to prevent bacterial infection after operation of chronic sinusitis. It was proved that no loss of potency occurred upon heat sterilization and that it was stable even after storage for a long period. This gauze tampon was easy to insert into the paranasal sinuses, achieving satisfactory therapeutic efficacy in terms of hemostasis and disinfection. No adverse reactions have been observed.

Stab wounds of the chest occupy an important position in penetrating thoracic injuries in Japan. A retrospective review of 117 patients with stab wounds of the chest admitted to our hospital over the past 12 years (from 1975 to 1987) revealed some factors that might influence their mortality. Seven patients died from trans-diaphragmatic injuries of intra-abdominal organs. The management of intra-abdominal injuries was very important in thoracic stab wounds. Many of the patients with stab wounds of the precordial chest (danger zone) had cardiac or major vascular injuries, and the mortality rate of them was high. The mortality rate of the patients with stab wounds of the right lateral thorax was high, because many of them had trans-diaphragmatic liver injuries. We thought that right lateral thorax as well as precordial chest is the danger zone in thoracic stab wounds. Survival rate in the patients whose circulatory condition had been unstable when they admitted was very low. Five DOA (dead on arrival) patients with stab wounds of the chest required emergency room thoracotomy (ERT). One of them survived. Survival rate in the DOA patients with stab wounds of the chest was higher than that in the DOA patients with blunt thoracic injuries. ERT for cardiac insufficiency following stab wounds of the chest was thought an effective procedure for surviving. Survival rate of the patients with cardiac stab wounds was 63.6 per cent.

Mucocele of the appendix is rare and mainly found incidentally at surgery or autopsy. Clinically, this tumor is known to cause pseudomyxoma peritonei or intussusception in adults. We present a case of adult intussusception with a leading mass of appendiceal mucocele. Computed tomography was useful in resolving the nature of the leading mass.

Nifedipine is a calcium antagonist used for the treatment of hypertension and angina pectoris. However, commercial nifedipine preparations are only available in forms suitable for oral administration, e.g. soft capsules and tablets. Therefore, we developed a suppository form in which the drug was incorporated into a hollow type suppository. The suppository preparation was administered to humans for evaluation of the clinical and commercial usefulness. It was as fast-acting as the soft capsule, but the blood concentration of nifedipine immediately after administration was lower than that seen with the soft capsule. It was considered to be superior to the soft capsule and similar to the tablet in terms of its long-acting effect. Thus, the hollow type suppository form of nifedipine should have useful clinical applications.

Two distinct antigen systems (L26 and L27) specifically expressed in human B lymphocytes were identified using TB2-2B3 (2B3) and T3-5B3 (5B3) monoclonal antibodies, respectively. Whereas L26 antigen defined by 2B3 were rarely expressed on the surface of B cells but abundant in the cytoplasm, 127 antigens detected by 5B3 was clearly expressed on the cell surface. These two antigens appeared to be restricted in their expression to B cells, as they were found in most B cells but not other cell types including thymocytes, T cells, monocytes and granulocytes. Functional studies demonstrated that L27 was more easily lost from B cells after activation with pokeweed mitogen than was L26. Likewise, plasma cell myeloma, as well as normal plasma cells, was devoid of both L26 and L27, whereas immunoblastic sarcoma of B cell type expressed L26 but not L27. These two antigens co-existed in the same B cell lines including Epstein-Barr virus transformed B cell lines, B cell type acute lymphatic leukaemia (B-ALL) cell line, Burkitt's lymphoma cell lines and myeloma cell lines, but pre-B and common ALL cell lines were entirely negative for both L26 and L27. Immunoprecipitation studies showed that L26 consisted of at least two polypeptide chains with molecular weights of 30K and 33K daltons, which were clearly distinct from HLA-DR antigens. The antigen L27 is presently under study.

Right ventricular (RV) function in terms of hemodynamics and RV wall motion was studied in 14 mongrel dogs during left heart bypass (LHB) using a centrifugal blood pump. The wall motion was analyzed by two-dimensional echocardiography (2D-echo). Incremental changes in LHB flow ratios of 0% (controls), 25%, 50%, 75% and a maximum 85-100% were accompanied by decrements of segmental shortening of the interventricular septum (IVS) by 54 +/- 12%, 43 +/- 5%, 42 +/- 2%, 35 +/- 0% and 0%, respectively. In addition to akinesis of the IVS during maximum flow, a specific part of the RV free wall adjacent to the IVS also had marked depression of contractions and overall RV contraction was nearly dependent on the RV free wall opposite to the IVS. Maximum LHB flow induced complete depression of the left ventricular cavity, a marked increase in RV volume, and depression of the RV ejection fraction on 2D-echo. Excessive or prolonged LHB reduces the RV wall motion capability and may lead to right heart failure. Our results suggest that an LHB ratio of about 75% is optimum to maintain normal cardiac function, particularly that of the right heart.

Investigation of the regional threshold for epilepsy in many structures in the brain would contribute to the study of epileptogenesis. So we studied the threshold for epileptiform afterdischarge in the neocortex, hippocampus and cerebellar cortex using Na-Penicillin -G (Pc) of which epileptogenesis has been intensively investigated. In order to eliminate the influence from the outside of these structures, the brain slice method was utilized. Procedures for preparation of the tissue and incubation were about the same as those described by Yamamoto. In summary, after sacrifice, brain of the guinea pig was taken out and the hippocampus, neocortex and cerebellum were cut with a razor blade under a microscope. The thickness of the section was about 0.3 mm. Slices were incubated at 37 degrees C for about 30 min in the standard medium perfused with 95% O2 and 0% CO2. The chamber was continuously perfused with the standard medium which composed of NaCl, 124 mM, KCl, 5: KH2PO4, 1.24; MgSO4, 1.3; CaCl2, 2.4; NaHCO3, 26; and glucose, 10. Evoked potentials were elicited by electrical stimulation in the standard medium. Mossy fibers were stimulated and responses were recorded from the CA3 area in the hippocampus by glass pipette microelectrode. Subcortical white matter was stimulated and responses were recorded from the Purkinje cell layer in the cerebellum. Pc was added in the standard medium until epileptiform afterdischarges were superimposed on the evoked potentials. The results of this experiment demonstrated that each structure in the brain has a regional own threshold for Pc induced epileptiform afterdischarge.(ABSTRACT TRUNCATED AT 250 WORDS)

Estracyt (estramustine phosphate) is a nitrogen mustard derivative of estradiol-17 beta which is rapidly dephosphorylated to yield estramustine. Estramustine is metabolized to estromustine mainly in the liver. Both estramustine and estromustine are retained in rat prostate with a high degree of specificity. This retention is due to the binding of estramustine and/or estromustine to a protein called EMBP (estramustine binding protein). When estimated by HPLC, the molecular weights of these estramustine binding components in rat prostate are 45,000-50,000 and 25,000-30,000, respectively. HPLC and glycerol density gradient analysis clearly demonstrated the occurrence of EMBP in a cytosol preparation from human prostatic cancer tissue. When estimated by HPLC, the molecular weights of estramustine binding components are 45,000 and 25,000 daltons, respectively. In addition, results of effectiveness of Estracyt studied under a cooperative research group in Japan, are reported in this paper. Effectiveness was evaluated at 3 months of the treatment on 121 patients with untreated prostatic cancer (Study I) and 95 patients with reactivated cancer (Study II), at 12 months of the treatment on 68 patients in Study I and 85 patients in Study II, and at 24 months on 37 patients in Study I and 23 patients in Study II. At 3 months of the treatment, Estracyt was effective in 89% of untreated prostatic cancers, and 38% of reactivated prostatic cancers. At 24 months of the treatment, this drug was effective in 65% of untreated prostatic cancers and 30% of reactivated ones. Estracyt is especially recommended as a first-choice drug for both the untreated patients with poorly differentiated adenocarcinoma and reactivated cancer.

Cerebral function during acutely increased ICP as well as during the recovery period were evaluated using visual evoked potential (VEP) and regional blood flow (rCBF) monitoring.

Three hundred and one patients undergoing aortic surgery (247 aneurysm cases and 54 arteriosclerotic obstruction cases) were evaluated in respect to the treatment for the associated coronary artery stenosis. Twenty-four among total cases (8%) showed the presence of coronary artery stenosis; 16 cases among aneurysm cases (6.5%) and 8 cases among arteriosclerotic obstruction cases (14.8%). Coronary revascularization was performed in 10 cases and the early operate death was observed in one case. Two abdominal aneurysm cases and 4 arteriosclerotic obstruction cases received two-staged aortic and coronary operation, since either aortic or coronary lesion was considered lethal. However, 3 cases of dissecting aneurysm (type I or II), and case of arteriosclerotic obstruction case having left ventricular aneurysm received simultaneous aortic and coronary surgery, since both of the lesions were highly lethal. These data are consistent with the conclusion that the combined aortic and coronary lesion should be treated with the two-staged operation, and that the simultaneous aortic and coronary surgery should be performed only when the both lesions are lethal.

Aim: In order to clarify the changes in brain stem function associated with an increase of the intracranial pressure (ICP) situation, we have investigated the changes of auditory brain stem evoked response (ABR), increasing and decreasing ICP at various levels. In this experiment, special care was taken not to distort the brain stem structure so as to produce purely elevated ICP.

Many nasal sprays used in the treatment of rhinitis contain a steroidal agent, giving rise to fear of side effects when they are used frequently and continually. Accordingly, we undertook the development of a nasal spray containing oxaprozin, a nonsteroidal anti-inflammatory agent. Suitable discharge pressure and surfactants were determined by applying trial aerosols to human subjects in "feeling" tests to assess approval rating. Other tests showed that about 80% of the expelled oxaprozin was released into the nasal cavity, and that the chosen formulation caused only a low level of irritation to the nasal mucosa. Most of the aerosol particles were found to adhere to Kiesselbach's area and the frontal region of the inferior concha, which are the major areas where inflammation and nasal haemorrhage occur. When the nasal spray was administered to 50 patients, a sufficient therapeutic effect was achieved, especially in the treatment of nasal haemorrhage, and side effects have not yet been detected.

We have studied the effects of extracorporeally induced systemic hyperthermia on cell-mediated immunity in 12 patients. Also, the effect of heating and anti-cancer drugs on ADCC activity 3 Plaque forming method and 51Cr release method) and NK activity (51Cr release method. target: K-562 cells) of normal human lymphocytes was studied in vitro. The following results were obtained: Lymphocytes, T-cells and IgGFcR+ T-cells counts slightly decreased during the hyperthermotherapy in patients. During initiation of the hyperthermotherapy (Rectal temp. 41.6-41.8 degrees), ADCC activity, PHA, and Con-A induced lymphocyte blastogenesis were slightly depressed, while NK activity was slightly enhanced. At the end of the hyperthermia, ADCC activity, lymphocyte blastogenesis and NK activity were extremely depressed. In vitro, 1 hour of heating at more than 40 degrees C extremely depressed ADCC activity. By heating at 42 degrees C, ADCC activity was depressed depending on heating time, while NK activity was slightly enhanced for the first 10 minutes and then depressed depending on heating time. The administration of anti-cancer drugs (MMC, 5-FU, ADM) did not affect NK activity at all during the heating at 42 degrees C. From these results, it is highly suggested that immunopotentiators should be used during extracorporeally induced systemic hyperthermia in order to make up for the depressed cell-mediated immunity.

Prior to our report of the automatic ICP controller, we would like to emphasize the important premises, that is, the general physical condition especially the respiratory and circulatory systems needed to maintain proper blood gas tension level, the use of corticosteroid for the prevention and reduction of cerebral edema, and the elimination of intracranial masses checked with repeated CT.

The purpose of this study is to analyze the early and late results of left ventricular aneurysmectomy in patients with mitral regurgitation secondary to myocardial infarction. Twenty patients who had left ventricular aneurysm combined with mitral regurgitation underwent the isolated or combined aneurysmectomy during the last 10 years. There were 18 male cases and 2 female cases, and their age ranged from 31 to 64 (mean age 52.6 years). In 19 cases, the left ventricular aneurysm were caused secondary to antero-septal infarction due to the occlusion of the left anterior descending coronary artery. In one case, the coronary spasm of circumflex artery provoked the posterolateral myocardial infarction and the tendon rupture of posterior papillary muscle. The isolated left ventricular aneurysmectomy were performed in 6 cases and the combined operations were coronary artery bypass grafting in 11 cases, mitral annuloplasty in 1 case, mitral annuloplasty and bypass grafting in 1 case, and mitral replacement in 1 case. There were no operative death cases. The preoperative mean functional class (NYHA classification) was 2.9 and the postoperative class was 1.4. The preoperative mitral regurgitation of grade 1 in Sellers' classification was observed in 11 cases. Grade 2 regurgitation was observed in 6 cases, grade 3 in 2 and grade 4 in 1. After surgery, mitral regurgitation more than grade 2 was recognized in 3 cases (group A) and regurgitation less than grade 1 was seen in 17 cases (group B).(ABSTRACT TRUNCATED AT 250 WORDS)

To evaluate graft patency and myocardial viability after aorto-coronary (AC) bypass surgery, 58 patients (29 with old myocardial infarction and 29 with effort angina) underwent symptom-limited exercise 201T1 myocardial SPECT using a bicycle ergometer before and after surgery. The results were as follows: 1. The overall angiographic graft patency was 87% (97 of 112 grafts). 2. According to the stress SPECT images, graft patencies were 98% for areas with postoperative improvement by 201T1 uptakes, 79% for areas with unchanged patterns, and 53% for areas with worsened patterns. In spite of patent grafts, among cases with worsened 201T1 uptakes the etiologies included perioperative infarction, anastomotic strictures, and poor run-off distal to the anastomoses. 3. Following patency of grafts, postoperative normalized perfusion patterns were observed in 69% (27 of 39 segments) of segments with persistent preoperative low uptakes and 25% (4 of 16 segments) of segments with persistent preoperative defects. Thus, exercise 201T1 myocardial SPECT proved a useful diagnostic means of assessing graft patency and effectiveness. However, after AC bypass surgery, 25% of the regions which had persistent defects before surgery exhibited normal perfusion patterns. These findings suggest that persistent defects may represent hypoperfusion of viable myocardium, and that we should carefully diagnose myocardial scars.