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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science (JSPS) Introduction Elevated left ventricular (LV) filling pressure in non-decompensated state is a powerful indicator of worse clinical outcomes in heart failure regardless of LV ejection fraction. However, its detection is often challenging in heart failure with preserved ejection fraction (HFpEF). Purpose This study aimed to elucidate the predictive value of recently proposed echocardiographic parameter of LV filling pressure, Visually assessed time difference between the Mitral valve and Tricuspid valve opening (VMT) score in HFpEF. Methods We retrospectively analyzed 310 well-differentiated HFpEF patients in stable conditions. Using two-dimensional echocardiographic images, time sequence of opening of mitral valve and tricuspid valve was visually assessed in the apical four-chamber view and scored to 0 to 2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava diameter was dilated, 1 point was added and VMT score was calculated as four grades from 0 to 3. Based on the previous study, VMT≥2 was regarded as a sign of elevated LV filling pressure (Figure 1). LV diastolic function was graded according to the guidelines. The primary endpoint was defined as a composite of cardiac death and heart failure hospitalisation during the two years after echocardiographic examination. Results During the follow-up period, 55 events (18%) occurred, including four cardiac deaths and 51 heart failure hospitalisations. Kaplan-Meier curves demonstrated that VMT≥2 (n = 54) was associated with worse outcomes compared to patients showing VMT ≤ 1 (n = 256) (log-rank test P Conclusions In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it discriminated worse clinical outcome even in HFpEF patients with atrial fibrillation. Abstract Figure. VMT scoring Abstract Figure. Kaplan-Meier analysis

Background Sarcoidosis is a systemic granulomatous disease that affects multiple organs. Among these, the presence of cardiac involvement is recognised as a determinant of worse clinical outcomes. Soluble interleukin 2 receptor (sIL-2R) is a potentially useful biomarker in the diagnosis and evaluation of disease severity in patients with sarcoidosis. However, it remains to be seen whether sIL-2R is associated with the severity and activity of disease in patients with cardiac sarcoidosis (CS). Purpose The aims of this study were to investigate whether sIL-2R was associated with clinical outcomes and to clarify the relationship between sIL-2R levels and disease activity evaluated by 18F-fluorideoxyglucose in positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with CS. Methods We examined 101 consecutive patients with CS who were admitted to our University HospitalbetweenMay 2003 and February 2020. Patients who had no data of serum sIL-2R levels before initiation of immunosuppressive therapy (n=18) were excluded. Ultimately, 83 patients were examined in this study. The primary outcome was a composite of advanced atrioventricular block (AVB), ventricular tachycardia or ventricular fibrillation (VT/VF), heart failure hospitalisation, and all-cause death. Inflammatory activity in the myocardium and lymph nodes were assessed by18F-FDG PET/CT. We used a published program to analyse the cardiac metabolic activity (CMA), and total lymph node glycolysis (TLyG), which are quantitative measures of FDG volume-intensity. Results During a median follow-up period of 2.96 (interquartile range 2.24–4.27) years, the primary outcome occurred in 24 patients (29%), including 1 advanced AVB, 13 VT/VF, 5 hospitalisations for heart failure, and 5 all-cause deaths. Kaplan-Meier analyses showed that the primary outcome occurred more frequently in patients with higher sIL-2R levels (>538 U/mL, the median) than in those with lower sIL-2R levels (Figure). A multivariable Cox regression analysis revealed that a higher sIL-2R level was independently associated with an increased subsequent risk of adverse events (hazard ratio 3.71, 95% confidence interval 1.63–8.44, p=0.002), even after adjustments for age, plasma B-type natriuretic peptide, estimated glomerular filtration rate, left ventricular ejection fraction, and late gadolinium enhancement, which are known to be strong determinants of worse clinical outcomes in patients with CS (Table). Furthermore, sIL-2R levels were significantly correlated with TLyG, the inflammatory activity in lymph nodes (r=0.346, p=0.003) but not with CMA, the inflammatory activity in myocardium (r=0.131, p=0.27). Conclusions Increased sIL-2R is associated with worse long-term clinical outcomes accompanied by increased systemic inflammatory activity in CS patients. These findings suggest the importance of assessing sIL-2R as a surrogate marker for further risk stratification in these patients. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science

A novel high-resolution X-ray diffraction (HR-XRD) apparatus for patterned epitaxial thin films has been developed using a convergent micro X-ray beam and a 2D detector. The micro-spot and high-flux (6 × 107 photons/s) X-ray beam was achieved by using a hybrid mirror that consists of a bent crystal and a multilayer mirror and enabled measurement of patterned film in a 50 µm square (pad) area. We demonstrated rocking curve (RC) measurements of a Si (1−x) Ge x epitaxial thin film (x was 13.5% and thickness was 50nm) and calculated Ge concentration, thickness, strain, and stress based on the measured results. We obtained precision (3c) of Ge concentration of 0.10% by 100 s and 0.27% by 10 s X-ray exposure time by the analysis. We also carried out reciprocal space mapping (RSM) of the Si (1−x) Ge x and we obtained that Ge concentration of 13.38% using RSM data, whereas 13.46% using RC measurement data. We confirmed that the HR-XRD tool enabled short time measurement and making it appropriate for in-line inspection of Si (1−x) Ge x and other thin crystalline films on patterned wafers.

Critical dimension small-angle x-ray scattering (CD-SAXS) with a grazing-incidence geometry, which was recently developed by the authors, has been successfully applied to the cross-sectional profile measurements of different types of L/S- and hole-type patterns on photoresist surfaces. We have calculated diffraction intensities from the nanostructures based on a distorted wave Born approximation method to take the refraction and the reflection at the interfaces between layers into account, and the average cross-sectional profiles have been analyzed by a model-based least-square method. From the precise analyses, slight cross-sectional profile differences of a few nanometers scale generated by using different material and exposure conditions have been identified. The obtained cross-sectional profiles showed good agreements with the results obtained by cross-sectional scanning electron microscopy (SEM). These results demonstrate the applicability of the CD-SAXS to the nanoscale structural metrology. It is expected that the CD-SAXS is also applicable to even smaller scale structures, e.g., those of EUV, NIL, or DSA, as the x-ray wavelength is well shorter than the critical lengths of these structures.

An avalanche photodiode detector has been commissioned to measure weak resonant x-ray magnetic scattering (RXMS) from induced magnetic polarizations in Cu layers in exchange-coupled Co/Cu multilayers using circularly polarized x-rays from synchrotron sources. The detector can count x-rays at rates of 10 7 photons s −1 ,g iving good estimates of the RXMS at superlattice Bragg peaks in a reasonably short time when count losses due to the time structure of the synchrotron x-rays are corrected for. RXMS superlattice Bragg peaks as small as 1 × 10 −4 in flipping ratio have been measured from aC o/Cu multilayer at the K absorption edge of Cu. The data are fitted by an oscillatory model magnetization profile in the Cu layers derived from a Ruderman–Kittel–Kasuya–Yosida theor yo fe xchange coupling adapted to a planar geometry.

A genetic algorithm (GA) technique has been implemented for determination of structural parameters of thin solid film and superlattice from the X-ray reflectivity and diffuse scattering data. The fundamental concepts underlying genetic algorithms are described along with examples of classical nanostructures illustrating successful application of GA. The method is demonstrated to be robust and flexible in comparison with conventional optimization techniques.

Specular and diffuse x-ray scattering are used to probe the mesoscopic structure of interfaces within two 30-period Mo/Si superlattices, grown on silicon and glass substrates by ion beam sputtering. The data are evaluated qualitatively and quantitatively on the basis of a distorted-wave Born approximation, which includes a correlating behavior of interface roughness in both the lateral and vertical directions. Different initial conditions of the substrate’s surface result in distinguishable characters of roughness replications in the direction of growth. The average value, lateral correlation and fractal dimension of roughness are found to be different in the two samples, which leads to differences in the reflective properties of multilayer mirrors.

Endoscopic stapling diverticulostomy (ESD) using an endostapler is a modification of the standard endoscopic treatment of Zenker's diverticulum (ZD). It is characterized by complete myotomy of the upper esophageal sphincter, with division of the common wall between diverticulum and esophagus, followed by immediate simultaneous closure of the divided edges with the staples. ESD was performed on 21 patients with ZD between January 1996 and October 1997. The results were then evaluated. Operation time averaged 22 min. Wide opening of the diverticulum and excellent hemostasis were achieved. All of the patients but one, who died postoperatively of myocardial infarction, resumed oral intake without any evidence of cervical sepsis or mediastinitis. Complete relief of dysphagia was achieved in all 20 patients. Hospital stay averaged 4.7 days (range, 2-7 days). The patients were followed up after ESD for a median time period of 12 months. No relapses were recorded. ESD is an effective endoscopic treatment for ZD that entails a low risk of complications and requires only a short period of hospitalization.

In this investigation we apply the x-ray reflectivity and diffuse scattering measurements to study the interface and surface morphology and bulk properties of SiO2 amorphous films grown on Si substrates. Three samples with different interface and surface roughnesses are analysed. Simultaneous fitting of both specular reflectivity and diffuse scattering curves allows the determination of precise values of surface and interface roughness, film thickness and bulk density of silicon dioxide films. The distorted-wave Born approximation is used for quantitative characterization of diffuse scattering from the samples. The structural parameters obtained by the x-ray method agree with atomic force microscopy results.

The pressures in the intercostal and interpleural spaces were measured in 20 patients using an 18 gauge epidural catheter to confirm accurate catheter positioning for continuous intercostal and interpleural local anaesthetic blockade. In the intercostal space the mean (SD) pressure was negative (-1.8 (0.3)) mmHg and positive (+2.1 (0.3)) mmHg at the end of inspiration and expiration respectively. In contrast, in the interpleural space although the pressure varied with the respiratory cycle it remained negative both at the end of inspiration (-8.3 (1.0)) mmHg and expiration (-2.1 (0.8)) mmHg. We conclude that measurement of intercostal and interpleural pressures with an epidural catheter is a straightforward procedure which may be helpful in confirming accurate catheter placement for continuous intercostal or interpleural local anaesthetic blockade.

The rapid development of minor-access surgery has greatly stimulated the design of new instruments to be more sophisticated and specialized. However, even the most sophisticated instruments available today still have significant drawbacks. As far as grasping forceps are concerned, one of the problems is the conventional mechanical articular joint with its nonlinear motion. With these articular joints, the grasping jaws are applied slantwise against the tissue, and therefore, the grasping force is not uniformly distributed over the grasping jaws. Thus, delicate tissues may slip out of the instrument or may be damaged by too strong a force. The authors' purpose was to design a technically entirely new instrument as a better approach to the problems of grasping forceps. They call this instrument the elastic jaws grasping forceps. The new design has a simple structure and should avoid the particular drawbacks of conventional laparoscopic instruments and be suitable and functionally useful for minor-access surgery.

Liquid polyvalent metals, such as Ge and Sn, have a particular structural feature characterized by a small hump on the larger wavevector side of the first peak in their structure factors. Effective pair potentials of these elements have been obtained from the X-ray structure factor data using the modified hypernetted-chain (MHNC) equation. The effective pair potential of typical normal liquid metal, Na, was also estimated for comparison. The results suggest that the structural features of Ge and Sn are rather sensitive to the part of the pair potential around the second peak of the pair distribution function, whereas in the case of liquid Na, its structural feature is almost determined by the part of the pair potential near the first peak region.

An in-house anomalous X-ray scatterig (AXS) method has been done for determiningcation distribution in ZnFe2O4, NiFe2O4 and NiAl2O4 spinels using the anomalous dispersion effect near the K absorption edges of Zn and Ni. When introduced the ratio (x) of the number of divalent cations of M element, MA, residing in the tetrahedral A-site to the total number of M element, x=MA/Mtotal, the measured intensity ratios of three reflection peaks with two energies close to the K edge of Zn or Ni can be quantitatively explained only by assigning the case where ZnFe2O4 is the normal type (x=1.0) and NiFe2O4 is the inverse type (x=0.0) spinel structure. On the other hand, the results for NiAl2O4 suggests that 15% of Ni2+ cations occupy the tetrahedral A-site (x=0.15) and the rest are octahedrally coordinated. The usefulness of the in-house AXS method is rather surprisingly well-recognized, particularly for obtaining the cation distribution in crystalline materials containing two elements of nearly the same atomic number.

A small-angle x-ray scattering technique has been applied for characterizing pore-size distribution in porous low-κ dielectric films. The data are collected in reflection geometry using offset θ/2θ scans for avoiding strong specular reflections from the film surface and its substrate. The effects of refraction and reflection at the film surface and interface are corrected by the distorted wave Born approximation. A Γ-distribution mode is used to determine the pore-size distribution in a film. The technique has been used to analyze porous methyl silsesquioxane films. The pore sizes were found to disperse in the range from subnanometer to several nanometers, and the results agree well with those obtained by the N2 gas adsorption technique.

Tellurium tetraethoxide reacts with primary thioamides at room temperature, forming nitriles in high yields. On the other hand, the reactions with amides are largely temperature-dependent, giving predominantly esters at 80 °C and nitriles at a higher temperature. Similarly, tellurium tetraethoxide readily induces the C–N bond cleavage of ureas to give carbamates and amines.

Grazing incidence small-angle x-ray scattering (GISAXS) is proposed as one of the candidates for characterizing cross section of nanostructure line grating pattern. GISAXS is expected as useful nondestructive tool for characterizing cross section. We developed GISAXS and evaluated the capability using the 4X nm resist line patterns and the 3X nm silicon gate line patterns. The GISAXS results are compared with TEM images to evaluate the reconstruction ability in cross section contour profile. The correlation is investigated between GISAXS and the reference tools such as CD-SEM and TEM in the values of CD, height and bottom corner radius. The static repeatability is also evaluated by performing measurement ten times. We report the results of GISAXS capability as cross sectional metrology tool in actual device of 4X and 3X generation.

A new circuit technique of deserializing for Gb/s serial communication such as "digital visual interface" for PC and "high-definition multimedia interface" for CE application is proposed. Vernier over sampling and alignment technique can achieve both low power and low bit error rate at high frequency operation in DVI/HDCP digital graphic communication receiver. VOSA circuit is simple and mostly digitally controlled, therefore it is robust and portable. Demonstrating VOSA performance, the circuit was implemented to the DVI digital flat panel communication link receiver as an analog front-end (AFE) with the industry standard 0.25mum CMOS process

We report detailed experimental results of the electronic transport properties of Cs-encapsulatcd single-walled carbon nanotubes (SWNTs) produced via plasma ion irradiation method. After fabricating field-effect transistor (FET) configuration using pristine and alkali metal ion irradiated SWNTs as channel, the electronic transport properties of these devices are investigated. As a result, pristine semiconducting SWNTs show p-type transport properties. On the other hand, it is clearly observed that Cs-encapsulated semiconducting SWNTs have n-type transport behavior. This phenomenon can be explained in terms of charge transfer from Cs atoms in SWNTs. Moreover, ambipolar property is obtained by measuring Li-encapsulated SWNTs FET.

We report experimental results of the electric transport properties of single-walled carbon nanotubes (SWNTs) functionalized by plasma ion irradiation method, where purified SWNTs and Cs-encapsulating SWNTs are used. SWNTs bundles are well dropped between source and drain electrodes of the field effect transistor (FET) configuration. Voltage-current characteristics, gate bias dependence, and measuring temperature dependence are investigated. It is found that purified SWNTs exhibit p-type semiconducting behavior. Transport measurements for Cs encapsulating individual SWNTs have also been performed, the result of which is discussed.

Pneumocephalus is a rare complication of epidural block. We report a case of pneumocephalus complicating an epidural blood patch performed 3 days after unintentional dural puncture. Pneumocephalus may occur during an epidural blood patch procedure, even if the epidural needle tip is within the epidural space.

Tellurium tetraethoxide reacts with primary thioamides at room temperature, forming nitriles in high yields. On the other hand, the reactions with amides are largely temperature-dependent, giving predominantly esters at 80 °C and nitriles at a higher temperature. Similarly, tellurium tetraethoxide readily induces the C–N bond cleavage of ureas to give carbamates and amines.

We evaluated the effects of continuous intra-articular and intra-bursal infusion of lidocaine on postoperative pain following shoulder arthroscopic surgery. Forty-one ASA I-II patients scheduled for shoulder arthroscopic surgery, were allocated into following four groups. The patients, after intra-articular arthroscopic surgery, either received intra-articular lidocaine (Group I, n = 10) or did not (Group III, n = 10). The patients after extra-articular arthroscopic surgery either received intra-bursal lidocaine (Group II, n = 11) or did not (Group IV, n = 10). Group I and Group II received 8 ml of 1% lidocaine intra-articularly and intra-bursally, respectively, at the end of surgery, followed by continuous infusion of 1% lidocaine at the rate of 2 ml.hr-1 for 24 hours. The intensities of postoperative pain were evaluated by Visual Analogue Scale (VAS), 2, 5, 8, 12, 18 and 24 hours after surgery, and by the number of patients' request for supplemental analgesic for 24 hours. The VAS scores and the number of analgesic requests were significantly lower (P0.05) in Group I than Group III, and in Group II than Group IV throughout the postoperative observation period. No adverse effects were observed during this study. We conclude that continuous intra-articular and intra-bursal infusion of lidocaine provides effective postoperative pain relief for shoulder arthroscopic surgery.

To investigate the possible relationship between altered expression (loss of membranous staining or nuclear accumulation) of beta-catenin and invasion/metastasis in early gastric cancer (EGC), beta-catenin was detected immunohistochemically in 116 cases of EGC, including 86 differentiated and 30 undifferentiated carcinomas. In parallel, immunohistochemical expression of c-erbB-2 was analyzed in all EGC cases. Regardless of histological type, altered expression of beta-catenin was found in 47% of mucosal carcinomas and 89% of carcinomas with submucosal invasion (p0.001). Of particular interest is that beta-catenin alteration was found in almost all EGCs with lymph node metastasis, even though no significant statistical comparison could be made. These results suggest that molecular changes resulting in abnormal beta-catenin expression participate in the process of submucosal invasion and metastasis. While loss of expression was preferentially observed in undifferentiated EGCs, nuclear accumulation was found exclusively in 24% of differentiated EGCs. c-erbB-2 was overexpressed in only 16% of differentiated EGCs but there was no correlation between this overexpression and invasion or metastasis. However, it is intriguing that 12 out of 14 cases with c-erbB-2 overexpression also showed altered beta-catenin expression, suggesting that both molecules are involved in the development of a certain set of differentiated EGCs.

We developed a new simple X-ray scattering method for determining the pore size distribution in porous low-k film on silicon substrate without the destruction of the low-k film. We succeeded to observe the tungsten in porous MSQ (Methyl Silses Quioxane) film by TEM after the filling of tungsten into the pores by tungsten chemical vapor deposition (CVD). Furthermore, we compared this Small Angle X-ray Scattering (SAXS) and Gas Adsorption (GA) and Positron Annihilation Lifetime Spectroscopy (PALS).

We evaluated the accuracy of a new disposable pump (Coopdech Syrinjector), which employed the negative pressure made by injecting fluid into the pump for continuous epidural infusion. Thoracic epidural catheter was placed at the T6-T8 level prior to the lung surgery. The continuous epidural infusion of 0.25% bupivacaine at 2 or 3 ml.h-1 was started immediately after the surgery. The residual volume of bupivacaine was recorded. From our results, the injection speed of Syrinjector was satisfactory for clinical use of continuous epidural infusion of bupivacaine. However, when this pump is reused or the volume of the residual local anesthetics is less than 10 ml, the infusion accuracy will be potentially imprecise.

Background and Study Aims: Direct visualization of the abdominal cavity by laparoscopy prior to multimodal treatment may be capable of improving the diagnostic precision of gastric cancer staging. The aim of this study was to evaluate whether diagnostic laparoscopy can influence treatment strategies in gastric cancer staged T3 and T4 by preoperative diagnostic tests. Patients and Methods: Extended diagnostic laparoscopy (EDL) was carried out in 111 patients with advanced gastric cancer staged T3 or T4 by computed tomography (CT) and endoluminal ultrasound (EUS). On Lauren's classification of gastric cancer, 46% of the lesions were of the intestinal type and 54% of the nonintestinal type. EDL was carried out with the patients under general anesthesia, and included visual inspection of the abdomen, with surgical exploration of initially inaccessible regions, laparoscopic ultrasound examination, peritoneal lavage, and biopsies. The information provided by laparoscopy was classified as 1) no additional information, 2) important additional findings independent of the tumor stage, 3) downgrading of the tumor to a more favorable stage, and 4) upgrading of the tumor to a less favorable stage. The results of EDL were then compared with those obtained by sonography, CT and EUS in combination. Results: EDL was performed successfully in 107 patients. In 56 of the 111 patients (50.5 %), no additional findings were obtained. In 5.4% of cases, additional unforeseen information was found, not connected with the tumor but altering the management. EDL altered the preoperative diagnosis in 51 of the 111 patients (46.0 %), leading to changes in management in 45 of them (40.5 %). EUS provided additional information in eight cases (7.2 % of the whole group, or 15.7 % of those in whom the diagnosis had to be changed). Four metastases were detected using EDL. It was possible to rule out peritoneal spread in four patients, but it was newly detected in 26. Conclusions: Additional information by EDL about the tumor stage in gastric cancer led to a modification of the therapeutic strategy in 40% of patients, in spite of earlier comprehensive diagnostic work-up using modern imaging procedures. EDL should therefore be mandatory if neoadjuvant treatment is planned, in order to avoid either undertreatment or overtreatment of this type of tumor.

We attempted a new regimen of low-dose CPT-11 on a 5-FU resistant recurrent rectal cancer patient with multiple lung metastases and a paraaortic lymph node metastasis. CPT-11 was administered at 25 mg/m2/day x 3/week by intravenous infusion. Serum CEA level decreased gradually with a half time of approximately 4 weeks. The lung metastases almost disappeared and the paraaortic lymph node was also reduced more than 50%. There were no adverse effects except slight alopetia. This treatment could be continued on an outpatient basis. These results suggest that low-dose CPT-11 may be more effective and tolerable than the conventional, CPT-11 therapy.

We describe a case presenting herpetic eruptions and pain in the left cranial and cervical regions, followed by right cranial polyneuropathy. The patient, a 66-yr-old male, developed a diphasic syndrome which was first characterized by herpetic eruptions on the whole of his left cranial and cervical regions with severe pain and left facial nerve palsy. Two weeks later, right multiple cranial nerve palsies of III, V, and VII and an increase in CSF protein appeared in a second phase. Neuroimaging technique (MRI) did not provide any evidence of brain involvement. The immediate use of steroid therapy led to improvement of the symptoms of cranial polyneuropathy. The clinical course suggests that reactivation of a latent herpes simplex virus may have been the etiologic cause of the cranial polyneuropathy. Steroid therapy should be applied to the treatment of cranial polyneuropathy in patients showing a similar pattern to this case.

Die Kamerafuhrung bei laparoskopischen Operationen kann heute von geeigneten Manipulatoren ubernommen werden. Die Korrektur erfolgt dabei mechanisch uber Pedal- oder Sprachsteuerung. Um eine weitergehende Entlastung des Operateurs zu erreichen, wurde ein automatisches Kamerafuhrungssystem auf der Basis des Farbtrackings klinisch evaluiert. Durch Farbsegmentation wird die Lage der Spitze des dominierenden Instruments „on-line“ berechnet und die Korrektur der Kameraposition kontinuierlich vorgenommen. Im klinischen Einsatz ergab sich eine Verminderung der Gewebskontakte der Teleskopspitze und eine Reduktion des Personalbedarfs. Der Zeitaufwand war im Vergleich zur manuellen Kamerafuhrung gleich.

We have studied the effects of calcium-channel blocker, verapamil, on procaine-induced local sensory block. Standardized tail-flick (TF) test was used to investigate the duration and intensity of procaine-induced local conduction block in rats. After obtaining baseline TF latencies (mean; 3.3 sec), two 100 microliters of 0.4% procaine alone, a combination of 0.4% procaine and verapamil (100 micrograms, or 200 micrograms), or a large dose of verapamil (200 micrograms) were injected to the opposite sites of the tail base and TF test was performed every five minutes for 45 minutes. A large dose of verapamil showed no prolongation of TF latencies. The administration of 0.4% procaine alone produced a significant increase of TF latencies and the peak effect of % MPE (percent maximum possible effect) was demonstrated at 4 minutes after the drug injection (mean % MPE; 37.0%). Coadministration of 0.4% procaine and two doses of verapamil produced significant increases of % MPE in a dose-dependent fashion. It was concluded that sensory block by procaine of the peripheral nerves is potentiated by coadministration of calcium-channel blocker, verapamil.

The present study was conducted to investigate the mechanism of antinociceptive action of ketamine in rats. Intraperitoneally administered ketamine showed antinociception in the tail flick (TF) and mechanical paw pressure (MPP) tests in a time- and dose-dependent manner. However, intrathecal ketamine, 50-1,000 micrograms, did not exert any antinociceptive effect in TF and MPP tests. In contrast to the antinociceptive actions of intraperitoneal ketamine in TF test in intact rats, ketamine did not produce any effect in spinally transected rats. Further, pretreatment with an intrathecal serotonin antagonist, methysergide, and an intrathecal alpha 2 adrenergic antagonist, yohimbine, abolished the antinociceptive effects of intraperitoneal ketamine in the TF and the MPP tests. The monoamine levels (noradrenaline, MHPG, 5-HT, 5-HIAA) in the spinal cord, which were measured by high performance liquid chromatography, increased after the intraperitoneal administration of ketamine. We conclude that the antinociceptive effects of ketamine involve an activation of the monoaminergic (noradrenergic and serotonergic) descending inhibitory system, and that spinal ketamine does not affect the responses to the acute noxious stimuli.

We investigated changes in plasma concentration of lidocaine during continuous epidural anesthesia in 21 patients undergoing hepatectomy. According to the extent of hepatectomy, patients were assigned into one of the three groups: partial resection group, lobectomy group, and extended lobectomy group. Lidocaine 2.0 mg.kg-1 with 1: 200,000 epinephrine was epidurally administered in a bolus followed by continuous infusion of lidocaine at the rate of 1.5mg.kg-1.h-1. Plasma lidocaine concentration in the extended lobectomy group showed a significantly higher value than those of other two groups (P0.05). Plasma lidocaine was detected in the extended lobectomy group at 12 hs after the surgery, but not in the other two groups. Furthermore we investigated the effects of prostaglandin E1 infusion in 7 patients undergoing extended lobectomy. Plasma lidocaine concentration was not increased in this group. In conclusion, we recommend caution regarding the dose of lidocaine administered for epidural anesthesia during hepatectomy; PGE1 infusion appears to be safe in patients undergoing extended hepatectomy.

The present study examined interactions between mu and delta opiate subtypes and serotonin. Noxious activity evoked by radiant heat (51 degrees C, 8 sec) was extracellularly recorded from single discriminated wide dynamic range (WDR) neurons in decerebrate spinally transected cats. DAGO (mu selective opioid agonist) 1 microgram or DPDPE (delta selective opioid agonist) 30 micrograms was combined with serotonin (n = 6 each) 250 micrograms. The dose of each drug by itself when administered intrathecally produced no suppression of noxiously evoked activity. Although the combination of DAGO and serotonin produced no significant suppression of noxiously evoked activity, DPDPE and serotonin produced significant suppression to 72.8 +/- 8.0 % (mean +/- SEM) of control values (P0.01). Intravenously administered naloxone 0.1 mg reversed the suppression produced by the DPDPE-serotonin combination. Our results suggest that combinations of serotonin and delta selective opiates may be more effective in suppressing noxiously evoked activity than combinations with mu selective opiates.

This study was conducted to evaluate the effects of oral clonidine and tizanidine, alpha 2 adrenergic agonists, as premedication for tetracaine spinal anesthesia in 63 gynecological patients. The patients were randomly allocated to one of six groups. Group 1 (n = 7), group 2 (n = 8) and group 3 (n = 7) received 13 mg of tetracaine intrathecally in 10 % glucose solution 2.6 ml. Group 4 (n = 13), group 5 (n = 14) and group 6 (n = 13) received 13 mg of tetracaine intrathecally in a volume of 2.6 ml of 10 % glucose solution which contained 0.65 mg of phenylephrine. As premedication, group 1 and 4 received 0.25 mg of oral triazolam; group 2 and 5 received 3 mg of oral tizanidine; group 3 and 6 received 0.15 mg of oral clonidine. Group 2 and 3, or group 5 and 6 (clonidine or tizanidine group, respectively) needed significant longer time for regression of Th10 sensory blockade than group 1 or 4 (triazolam). The time for appearance of postoperative pain and the time to require postoperative analgesics were longer in the groups which had received either clonidine or tizanidine than in the groups which had received triazolam. Heart rate and systolic blood pressure in group 6 (clonidine-tetracaine-phenylephrine group) showed significant decreases (P0.05) after the spinal anesthesia. We concluded that oral premedication of clonidine and tizanidine prolonged tetracaine spinal anesthesia. From the view point of the prolongation of spinal anesthesia and the hemodynamic stability, oral premedication with tizanidine seems to be useful.

We previously studied the fatigue and stress of anesthesiologists at work using a flicker photometer, visual reaction time test, questionnaires, and Holter EKG. In the present study, we investigated the fatigue and stress in seven junior anesthesiologists at work using a flicker photometer and a stabilo-meter. The stabilo-meter measures postural stabilization. We performed each test three times on each subject for a total of twenty-one times. The flicker test and the stabilo-test showed the increase in fatigue in 17 (18%) and in 16 tests (76%), respectively, in all seven subjects. Increase of fatigue in both the flicker and stabilo-tests was observed in 13 tests (61%) of 6 subjects. There was a good relationship between the flicker test and the stabilo-test. Therefore, the stabilo-test appears to be a useful method for investigating the fatigue of anesthesiologists.

The analgesic effects of morphine, buprenorphine and pentazocine examined by behavioral responses to tail-flick (TF) and colorectal distension (CD) were studied in rats. Animals were randomly divided into three groups; morphine (M) groups of 4 mg.kg-1 (n = 7), buprenorphine (B) groups of 0.03 mg.kg-1 (n = 8), pentazocine (P) groups of 3 mg.kg-1 (n = 8). After determinations of TF and CD values, animals were administered each analgesic intraperitoneally, and both procedures were repeated every 5 minutes until 40 minutes. Three drugs produced an almost same degree of increase in pain threshold for TF; % maximum possible effects (%MPEs) were approximately 30%. Similar patterns of increase in pain thresholds for CD were observed in M and B groups; %MPEs were approximately 20%. In contrast, P groups showed a significant increase in thresholds for CD compared to M and B groups; 20 minutes after intraperitoneal administration of P, %MPE was approximately 50%. These results indicate that there are different antinociceptive effects to somatic and visceral stimuli between M, B and P, and suggest that selective opioid agonists modulate responses to different kinds of noxious stimuli.

We studied the differential effects of morphine and non-steroidal anti-inflammatory drug (NSAIDs) on behavioral responses to tail-flick (TF) and colorectal distension (CD) in rats. Animals were randomly divided into three groups; morphine groups (4 mg.kg-1), flurbiprofen axetil groups (30 mg.kg-1) and aspirin DL-lysin groups (100 mg.kg-1). After determining control TF and CD values, animals received each analgesic intraperitoneally, and each procedure was repeated every 10 minutes for 30 or 40 minutes. NSAIDs produced a statistically significant increase in pain threshold for CD, but not for TF. In contrast, almost similar patterns of increase in pain thresholds for CD and TF were observed in morphine groups. The present study demonstrates that NSAIDs have a powerful antinociceptive effect on visceral pain evoked by CD.

It has been reported that subcutaneous administration of pancuronium produces prolonged neuromuscular blockade. The purpose of this study was to evaluate the antagonistic effect of neostigmine on neuromuscular blockade following subcutaneous injection of pancuronium in anesthetized patients. Fourteen male patients aged 32-67 yr, weighing 50-58 kg, and scheduled for surgical operation lasting more than 6 hr were included in the study. None of the patients had paresis. Anesthesia was induced with thiamylal and SCC. Patients under N2O-oxygen-enflurane (1.0-1.5%) anesthesia, were divided into two groups (n = 7 in each group). Group A was given an intravenous bolus of pancuronium 6 mg. Group B received pancuronium 6 mg subcutaneously in the ankle. Train-of-four responses were evaluated every 12s by measuring the force of thumb adduction produced in response to supramaximal stimulation of the ulnar nerve at the wrist. When the train-of-four ratios recovered to approximately 0.2 in groups A and B, a mixture of neostigmine 1.0 mg and atropine 0.5 mg was administered. The onset of fade in train-of-four responses was significantly more rapid in group A (intravenous administration) than in group B (subcutaneous administration). Time intervals to maximum train-of-four depression from pancuronium administration in groups A and B averaged 2.6 and 125.4 min, respectively. No significant differences in the recovery times of the train-of-four ratios from 0.2 to 0.7 following neostigmine administration in groups A and B were demonstrated. None of the patients who received pancuronium subcutaneously showed recurarization following neostigmine administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Far-advanced gastric carcinoma of the stomach remains a lethal disease, showing a particularly poor prognosis in the patients with linitis plastica type. Considering the high potential for biological malignancies, we attempted preoperative induction (neoadjuvant) chemotherapy against far-advanced cancer associated with distant metastases. Anticancer drugs used in this study were FAM or sequential MTX/5-FU. Neoadjuvant chemotherapy was carried out on 24 patients prior to surgery. The response to chemotherapy showed shrinking of massive nodal involvement in 50% (5/10) and complete disappearance of malignant ascites in 87.5% (7/8). The morphological improvement of primary gastric lesions was obtained in 9 out of 24 cases (37.5%). In 15 cases (68.2%) total gastrectomy was done with extended lymph node dissection. In one of 9 cases showing marked improvement, no viable cancer cells were seen in whole stomach associated with multiple foci of granulomatous lesions of regional nodes after 3 cycles of MTX/5-FU. Disease-free survival of neoadjuvant group showed a significant prolongation of its median survival of 14 months, compared to that of 4-6 months in the surgery alone group. Our result leads to the conclusion that the patients whose tumor was effectively destroyed by neoadjuvant chemotherapy had a good prognosis.

An extended technique to determine the pore size distribution and porosity of porous low-dielectric-constant (low-k) films using the grazing incidence small-angle x-ray scattering measurement method has been developed. The method employs a laboratory x-ray source. The calculation of the scattering intensity from the pores has also been modified for quantitative analysis. Taking account of the reflections and refractions at the film surface and interfaces, the method utilizes calculations based on the distorted-wave Born approximation. The obtained pore size distributions of silica-based porous low-k films agreed well with that of the N2 gas adsorption technique. The porosity and wall density of the porous low-k films were determined by using the scattering intensities and the film density. Furthermore, the anisotropic pore size distributions were detected by comparing the scattering curves along the parallel and the normal to the surface directions for an organic porous low-k film.