A new method for the quantification of β-glucan in plasma and its application in the diagnosis of postoperative infection

In order to correctly diagnose and treat severe postoperative infections, it may be critical to detect and differentiate between endotoxin derived from Gram-negative bacteria and/or β-glucan derived from fungi. In addition to the chromogenic assay, the turbidimetric kinetic assay has been performed for the quantification of endotoxin in plasma usingLimulus amebocyte lysate as previously reported. However, it is also known that β-glucan triggers the coagulation ofLimulus amebocyte lysate. In the present study, the differentiation of β-glucan from endotoxin and its clinical application were studied. Endotoxin was able to be inactivated in plasma using one-tenth dilution by 10 per cent ethanol or distilled water, followed by heating at 100°C for 120 min, without affecting the activity of coexisting β-glucan. The treated sample was then subjected to the turbidimetric kinetic assay using Toxinometer ET-201^®. Using this method, as little as 30 pg/ml of β-glucan in the plasma may be assayed separately, with the amount of circulating β-glucan in the plasma of normal subjects being less than 50 pg/ml. On the other hand, in patients with a fungal infection, the amount of β-glucan in their plasma was elevated significantly. Clinically, β-glucanemia may often occur in severe postoperative infection even if fungi are not detected.     

Comparative study of aorto-coronary bypass surgery using internal mammary artery grafts and saphenous vein grafts

From April, 1985, through March, 1988, 202 patients had aorto-coronary artery bypass (CABG). In two series of consecutive patients who underwent CABG alone with the saphenous vein (SVG) or the internal mammary artery (IMA), mortality, morbidity and postoperative angiographic findings were compared with two series. The mean number of grafts placed was 1.8 per patient (1 to 4 grafts) in IMA group and 2.2 per patient (1 to 4 grafts) in SVG group. Mortality was 3% in two groups. The intraoperatively mean blood flow of graft to LAD in SVG and the mean blood flow of free end of IMA had no significant difference. The early patency rate (1.5 months) was 96% for 177 grafts in IMA group, 97% for 100 with IMA-LAD anastomosis, and 95% for 221 grafts in SVG group, 97.7% for 88 with SVG-LAD anastomosis. Morbidity was not significantly different. Many reports suggested that the long-term patency rate was good within the IMAG. In conclusion, the usefulness of IMAG in Japanese patients should be more stressed in young patients.     

Pulsatile Total Artificial Heart Using a Reversible Rotary Pump

Abstract: A pump circuit was assembled and examined for use as an implantable artificial heart. The circuit consisted of a gear pump and 4 artificial heart valves. Mitral and pulmonary arterial valves were placed at the inflow port of the pump, and aortic and tricuspid valves were placed at the outflow port. The mitral and the tricuspid valves were connected to each reservoir at 10 mm Hg, and the aortic and the pulmonary arterial valves were connected to the head tanks at 80 and 20 mm Hg, respectively. The pump discharged pulsatile flows into both systemic and pulmonary arteries alternately by switching the direction of rotation periodically. Because the rated discharge was 1.7 L/min for the gear pump used, the measured flow rate was 0.8-0.75 L/min at a heart rate of 60–110 bpm.     

Computer-analyzed EEG before and after bypass surgery: Quantification by a computerized wave form recognition method

Chronological changes of the EEG before and after extracranial-intracranial arterial bypass surgery were studied on 12 patients with minor completed stroke of the carotid circulation. Instead of a power spectrum used in the conventional computer analysis, a wave form recognition method, which well correlated with visual assessment of The EEG, was applied to the present computer analysis of The EEG. The EEG changed mainly in the parietal, occipital, anterior and middle temporal records of the affected cerebral hemisphere. Deterioration of the EEG continued until 1 month, and improved gradually during 3 and 6 months after the operation. However, it was difficult to conclude that the EEG improved by surgery.     

Gastric cytoprotection by pirenzepine in rats: evaluating method for cytoprotective activity by antisecretory agents

The effects of antisecretory agents, pirenzepine, atropine and cimetidine, on gastric mucosal lesions induced in rats by ethanol, HCI (0.6 N), HCI-acidified 50% ethanol and HCI-acidified 50 mM sodium taurocholate (TCA) were comparatively studied with PGE2. The involvement of gastric acid in the formation of ethanol-induced necrosis was also studied. PGE2 and pirenzepine inhibited necrosis induced by all necrotizing agents at the non-antisecretory doses, and the cytoprotective effect of pirenzepine was not abolished by indomethacin. Atropine and cimetidine did not inhibit HCI-induced necrosis even at the antisecretory dose. Atropine and cimetidine at the antisecretory dose inhibited necrosis induced by ethanol, but did not inhibit the red streaks. The ethanol-induced necrosis was also inhibited by neutralizing intragastric H+ with Tris buffer. In gastric fistula rats, alkalinization of the lumen was observed by exposure to ethanol, but necrosis was not produced. There is a close relationship between the necrosis and intragastric acid. Thus it is assumed that gastric acid is involved in the formation of ethanol-induced necrosis. It was suggested that pirenzepine possesses cytoprotective action which is not related to endogenous PGs. On the other hand, the antiulcer actions of atropine and cimetidine may be due, in a part, to antisecretory effects.     

Radiotherapy in trimodal combination therapy of maxillary sinus squamous cell carcinoma

From May 1979 to December 1982, 31 patients with reappraisable preoperative CT were treated with trimodal combination therapy for maxillary sinus squamous cell carcinoma. The three-year cumulative survival rate of all cases was 43% and the two-year cumulative local control rate was 44%. The 5-FU distribution in infusion chemotherapy was reappraised by the dye method and the radiation field was reappraised on the basis of preoperative CT. Only patients who received suitable infusion chemotherapy and radiotherapy showed a good local control rate. Suitably performed infusion chemotherapy and radiotherapy were essential in our trimodal combination therapy. Radiotherapy must be planned according to the individual patient on the basis of the preoperative CT and surgical findings.